scholarly journals Infectious events in patients with severe COVID-19: results of a cohort of patients with high prevalence of underlying immune defect

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anastasia Saade ◽  
Giulia Moratelli ◽  
Guillaume Dumas ◽  
Asma Mabrouki ◽  
Jean-Jacques Tudesq ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cumulative Incidence ◽  
Cumulative Risk ◽  
Incidence Density ◽  
Hospital Acquired Infections ◽  
Underlying Malignancy ◽  
Single Center Study ◽  
High Prevalence ◽  
Immune Defect ◽  
Hospital Acquired

Abstract Background Empirical antibiotic has been considered in severe COVID-19 although little data are available regarding concomitant infections. This study aims to assess the frequency of infections, community and hospital-acquired infections, and risk factors for infections and mortality during severe COVID-19. Methods Retrospective single-center study including consecutive patients admitted to the intensive care unit (ICU) for severe COVID-19. Competing-risk analyses were used to assess cumulative risk of infections. Time-dependent Cox and fine and gray models were used to assess risk factors for infections and mortality. Propensity score matching was performed to estimate the effect of dexamethasone. Results We included 100 patients including 34 patients with underlying malignancies or organ transplantation. First infectious event was bacterial for 35 patients, and fungal for one. Cumulative incidence of infectious events was 27% [18–35] at 10 ICU-days. Prevalence of community-acquired infections was 7% [2.8–13.9]. Incidence density of hospital-acquired infections was 125 [91–200] events per 1000 ICU-days. Risk factors independently associated with hospital-acquired infections included MV. Patient’s severity and underlying malignancy were associated with mortality. Dexamethasone was associated with increased infections (36% [20–53] vs. 12% [4–20] cumulative incidence at day-10; p = 0.01). After matching, dexamethasone was associated with hospital-acquired infections (35% [18–52] vs. 13% [1–25] at 10 days, respectively, p = 0.03), except in the subset of patients requiring MV, and had no influence on mortality. Conclusions In this population of COVID-19 patients with high prevalence of underlying immune defect, a high risk of infections was noted. MV and use of steroids were independently associated with infection rate.

scholarly journals Incidence and risk factors for hospital-acquired infection among paediatric patients in a teaching hospital: a prospective study in southeast Ethiopia

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e037997
Author(s):  
Biniyam Sahiledengle ◽  
Fekadu Seyoum ◽  
Daniel Abebe ◽  
Eshetu Nigussie Geleta ◽  
Getahun Negash ◽  
...  
Keyword(s):  
Risk Factors ◽  
Teaching Hospital ◽  
Cumulative Incidence ◽  
Severe Acute Malnutrition ◽  
Acute Malnutrition ◽  
Secondary Outcome ◽  
Hospital Acquired Infections ◽  
Paediatric Patients ◽  
Southeast Ethiopia ◽  
Hospital Acquired

ObjectivesIn order to maximise the prevention of hospital-acquired infections (HAIs) and antimicrobial resistance, data on the incidence of HAIs are crucial. In Ethiopia, data about the occurrence of HAIs among hospitalised paediatric patients are lacking. We aim to determine the incidence and risk factors of HAIs among paediatric patients in Ethiopia.DesignA prospective cohort study.SettingA teaching hospital in southeast Ethiopia.Participants448 hospitalised paediatric patients admitted between 1 November 2018 and 30 June 2019.Primary and secondary outcome measuresIncidence and risk factors of hospital-acquired infections.ResultsA total of 448 paediatric patients were followed for 3227 patient days. The median age of the patients was 8 months (IQR: 2–26 months). The incidence rate of HAIs was 17.7 per 1000 paediatric days of follow-up; while the overall cumulative incidence was 12.7% (95% CI 9.8% to 15.8%) over 8 months. Children who stayed greater than 6 days in the hospital (median day) (adjusted risk ratio (RR): 2.58, 95% CI 1.52 to 4.38), and children with underlying disease conditions of severe acute malnutrition (adjusted RR: 2.83, 95% CI 1.61 to 4.97) had higher risks of developing HAIs.ConclusionsThe overall cumulative incidence of HAIs was about 13 per 100 admitted children. Length of stay in the hospital and underlying conditions of severe acute malnutrition were found to be important factors associated with increased risk of HAIs.

scholarly journals Epidemiology of Surgical Site Infections Considering the NHSN Standardized Infection Ratio in Hip and Knee Arthroplasties

2020 ◽  
Vol 17 (9) ◽  
pp. 3167
Author(s):  
Róża Słowik ◽  
Małgorzata Kołpa ◽  
Marta Wałaszek ◽  
Anna Różańska ◽  
Barbara Jagiencarz-Starzec ◽  
...  
Keyword(s):  
Optimal Solution ◽  
Surgical Site Infections ◽  
Incidence Density ◽  
Coagulase Negative Staphylococci ◽  
Surveillance Network ◽  
Hospital Acquired Infections ◽  
Etiologic Agents ◽  
Healthcare Associated ◽  
Hospital Acquired ◽  
And Control

Introduction Surgical site infections (SSIs) are a predominant form of hospital-acquired infections in surgical wards. The objective of the study was analysis of the incidence of SSI in, both primary and revision, hip and knee arthroplasties. Material and methods: The study was conducted in 2012–2018 in a Trauma and Orthopedics Ward in Tarnów according to the methodology of the Healthcare-Associated Infections Surveillance Network (HAI-Net), European Centre for Disease Prevention and Control (ECDC). Results: The surveillance comprised 2340 surgery patients, including: 1756 Hip Arthroplasties (HPRO) and 584 Knee Arthroplasties (KPRO). In the group of patients under study, 37 cases of SSI were detected, including: 26 cases of SSI after HPRO and 11 cases in KPRO. The average incidence of SSI amounted to 1.6% (1.5% HPRO and 1.9% KPRO) and in-hospital incidence density rates were 1.23 and 1.53 per 1000 patient-days, respectively. Median age of surgical patients in both HPRO and KPRO was 70 years. Women were undergoing arthroplasty surgery more often than men, HPRO (p < 0.05) and KPRO (p < 0.001). Patients with SSI stayed in the ward longer (SSI-HPRO, p < 0.001) (SSI-KPRO p < 0.01). In KPRO operations, the incidence of SSI was higher than expected, calculated according to the Standardized Infection Ratio (SIR). The most common etiologic agents isolated from SSIs in both HPRO and KPRO were coagulase-negative staphylococci. Conclusions: Establishing a thorough surveillance of hospital-acquired infections that takes into consideration epidemiological indicators is indispensable to properly assess the epidemiological situation in the ward. The optimal solution is to carry out long-term and multi-center surveillance in the framework of a uniform program, however, even results of single-center studies provide valuable data indicating challenges and needs in improving patient safety.

scholarly journals High prevalence of hospital-acquired infections caused by gram-negative carbapenem resistant strains in Vietnamese pediatric ICUs

Medicine ◽  
2016 ◽  
Vol 95 (27) ◽  
pp. e4099 ◽  
Author(s):  
Ngai Kien Le ◽  
Wertheim HF ◽  
Phu Dinh Vu ◽  
Dung Thi Khanh Khu ◽  
Hai Thanh Le ◽  
...  
Keyword(s):  
Gram Negative ◽  
Hospital Acquired Infections ◽  
Carbapenem Resistant ◽  
High Prevalence ◽  
Resistant Strains ◽  
Hospital Acquired

Malignant Lymphoma in Primary Sjögren Syndrome: Incidence and Risk Factors.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4991-4991
Author(s):  
Andrés López ◽  
Roser Solans-Laque ◽  
Josep A Bosch-Gil ◽  
Mercedes Gironella ◽  
Noelia Purroy ◽  
...  
Keyword(s):  
Risk Factors ◽  
Malignant Lymphoma ◽  
Cumulative Incidence ◽  
Soft Tissues ◽  
Conflicts Of Interest ◽  
Normal Population ◽  
Cumulative Risk ◽  
Systemic Autoimmune Rheumatic Disease ◽  
Low Levels

Abstract Abstract 4991 Background Primary Sjögren Symdrome (PSS) is the second common systemic autoimmune rheumatic disease whose main histological feature is a focal infiltration of the exocrine glands by activated B and T lymphocytes. PSS is considered a benign autoimmune condition with a chronic indolent course. However, several reports have noted an increased incidence of malignant lymphoma with an estimated risk of up to 44 times greater than in the normal population. The aims of the present study are to assess the cumulative incidence of lymphoma in patients diagnosed of PSS, as well as to identify risk factors for developing this condition. Methods All patients diagnosed since 1988 and followed-up for longer than 2 years at our institution, were included. The pathological, immunological, and clinical features of each case of PSS were retrospectively examined. These data were cross-examined with the cumulative incidence of lymphoma in this group of patients, in order to determine common findings in patients later developing lymphoid malignancies. Results 272 patients had been diagnosed as having a PSS in this time period, of which 244 [9 males, 235 females; median age 58 years (range 17 to 88)] had been followed for more than 2 years. After a median follow up of 9.6 years, 11 (4.5%) patients developed a lymphoma, after 6 to 171 months from diagnosis. The cumulative risk for developing lymphoma at 5, 10 and 15 years was 3.4, 4.1, and 9.3%, respectively. Risk factors associated with the development of lymphoma were skin purpura/vasculitis, lymphopenia and low levels of C3 and C4 complement fractions. Low levels of C3 and C4 were also found to be associated with an earlier development of lymphoma. Conversely, skin purpura/vasculitis and lymphopenia were both associated with the development of lymphoma at a later stage. The hystological analysis showed mucosal-associated lymphoid tissue lymphoma in 5 patients, diffuse large B cell in 3, and follicular lymphoma in 3 cases. Clinically, lymphomas had extranodal presentation in 8 out of the 11 cases, involving the salivary glands in 5, lacrimal glands in 1, and soft tissues and lung in 1 case, respectively. Only 3 patients had received immunosuppressive therapy prior to the diagnosis of lymphoma, and EBV was not found in the histological examination of any of these cases. Conclusion Patients with PSS are at a higher risk for developing lymphoma. Our study suggests low levels of C3 or C4, as well as the presence of purpura or lymphopenia delimitates a group of patients at a higher risk, so that such patients may benefit from a closer follow up. Disclosures No relevant conflicts of interest to declare.

scholarly journals The Prevalence and Estimates of the Cumulative Incidence of Hospital-Acquired Infections Among Patients Admitted to Auckland District Health Board Hospitals in New Zealand

2003 ◽  
Vol 24 (1) ◽  
pp. 56-61 ◽  
Author(s):  
Nicholas Graves ◽  
Tanya M. Nicholls ◽  
Christopher G. S. Wong ◽  
Arthur J. Morris
Keyword(s):  
New Zealand ◽  
Cumulative Incidence ◽  
Cost Effective ◽  
Point Prevalence ◽  
Health Board ◽  
District Health ◽  
Hospital Acquired Infection ◽  
Hospital Acquired Infections ◽  
Incidence Studies ◽  
Hospital Acquired

AbstractObjectives:To report the pooled results of seven prevalence surveys of hospital-acquired infections conducted between November 1996 and November 1999, and to use the data to predict the cumulative incidence of hospital-acquired infections in the same patient group.Design:The summary and modeling of data gathered from the routine surveillance of the point prevalence of hospital-acquired infections.Setting:Auckland District Health Board Hospitals (Auckland DHBH), the largest publicly funded hospital group in New Zealand supplying secondary and tertiary services.Patients:All inpatients.Method:Point-prevalence surveys were conducted including all patients in Auckland DHBH. Standard definitions of hospital-acquired infection were used. The data from the seven surveys were pooled and used in a modeling exercise to predict the cumulative incidence of hospital-acquired infection. An existing method for the conversion of prevalence to cumulative incidence was applied. Results are presented for all patients and stratified by clinical service and site of hospital-acquired infection.Results:The underlying patterns of hospital-acquired infection by site and service were stable during the seven time periods. The prevalence rate for all patients was 9.5%, with 553 patients identified with one or more hospital-acquired infections from a population of 5,819. The predicted cumulative incidence for all patients was 6.33% (95% confidence interval, 6.20% to 6.46%).Conclusions:The prevalence and the predicted cumulative incidence are similar to rates reported in the international literature. The validity of the predicted cumulative incidence derived here is not known. If it were accurate, then the application of this method would represent a cost-effective alternative to incidence studies.

scholarly journals Prevalence of Hospital Acquired Pneumonia in Intensive Care Units in Khartoum State (From April 2019 to September 2019)

2021 ◽  
pp. 1-4
Author(s):  
Amani Mohammed Ali Ahmed ◽  
◽  
Malaz Masaad Elsheikh Elkaki ◽  
Alsadig Kamal Elemam Albadri ◽  
Abdelhakam H Ali ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Kidney Injury ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Study Materials ◽  
High Risk Factors ◽  
High Prevalence ◽  
Renal Tubular ◽  
Hospital Acquired

Objectives: To determine the prevalence of nosocomial infections in intensive care unit (ICU), we performed a hospital-based study. Materials and Methods: Consecutive patients were enrolled and details of risk factors and bacteriological data were obtained. Statistical analyses were performed using spss version 24. Results: seventy six patients were admitted during the study period (minimum 10 years and maximum 91 years, men 69.7%, females 30.3%). Most important comorbidities were renal tubular acidosis (23.7%), cerebro vascular accidents (15.8%), and acute kidney injury (9.2%). Antibiotics were administered in 40.8%. Bacteriological cultures were positive in 42.1% (n=32). Gram negative bacteria were common–Klebsiella pneumoniae (27.6%), pseudomonas aerogenisa (7.95%), and Streptococcus pyogenes (2.6%) Escherichia coli (1.3%), Staphylococcus aurous (1.3%) and candida (1.3%). There a high prevalence of resistance to common antibiotics. Conclusions: There is high prevalence of infections in patients in a medical ICU in Khartoum – Sudan. Gram negative bacteria are the most prevalent and resistance to antibiotics is high. Risk factors are age and multiple comorbidities

scholarly journals Hospital ward design and prevention of hospital-acquired infections: A prospective clinical trial

2014 ◽  
Vol 25 (5) ◽  
pp. 265-270 ◽  
Author(s):  
Jennifer Ellison ◽  
Danielle Southern ◽  
Donna Holton ◽  
Elizabeth Henderson ◽  
Jean Wallace ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Rate Ratio ◽  
Incidence Rate Ratio ◽  
Controlled Trial ◽  
Care Facility ◽  
Hospital Ward ◽  
Incidence Density ◽  
Medical Patients ◽  
Hospital Acquired Infections ◽  
Hospital Acquired

BACKGROUND: Renovation of a general medical ward provided an opportunity to study health care facility design as a factor for preventing hospital-acquired infections.OBJECTIVE: To determine whether a hospital ward designed with predominantly single rooms was associated with lower event rates of hospital-acquired infection and colonization.METHODS: A prospective controlled trial with patient allocation incorporating randomness was designed with outcomes on multiple ‘historic design’ wards (mainly four-bed rooms with shared bathrooms) compared with outcomes on a newly renovated ‘new design’ ward (predominantly single rooms with private bathrooms).RESULTS: Using Poisson regression analysis and adjusting for time at risk, there were no differences (P=0.18) in the primary outcome (2.96 versus 1.85 events/1000 patient-days, respectively). After adjustment for age, sex, Charlson score, admitted from care facility, previous hospitalization within six months, isolation requirement and the duration on antibiotics, the incidence rate ratio was 1.44 (95% CI 0.71 to 2.94) for the new design versus the historic design wards. A restricted analysis on the numbers of events occurring in single-bed versus multibed wings within the new design ward revealed an event incidence density of 1.89 versus 3.47 events/1000 patient-days, respectively (P=0.18), and an incidence rate ratio of 0.54 (95% CI 0.15 to 1.30).CONCLUSIONS: No difference in the incidence density of hospital-acquired infections or colonizations was observed for medical patients admitted to a new design ward versus historic design wards. A restricted analysis of events occurring in single-bed versus multibed wings suggests that ward design warrants further study.

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