scholarly journals Risk factors for unfavorable clinical outcomes in patients with brain abscess in South Korea

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0257541
Author(s):  
Yun Suk Cho ◽  
Yu Jin Sohn ◽  
Jong Hoon Hyun ◽  
Yae Jee Baek ◽  
Moo Hyun Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
South Korea ◽  
Clinical Outcomes ◽  
Brain Abscess ◽  
Charlson Comorbidity Index ◽  
Tertiary Care ◽  
Significant Risk ◽  
Neurological Deficits ◽  
Care Hospital ◽  
Comorbidity Index

Background Brain abscess can be life-threatening and manifest various neurological findings, although the mortality rate has decreased recently. We investigated the risk factors for unfavorable outcomes of patients with brain abscess. Methods A retrospective cohort study examined patients with brain abscess seen from May 2005 to December 2018 in a tertiary care hospital in Seoul, South Korea. We reviewed the medical records for clinical findings, therapeutic modalities, and prognostic factors of brain abscess. Unfavorable clinical outcomes were defined as death, moderate to severe disability with neurological deficits, or vegetative state at 1 year or at the time of discharge from outpatient follow-up. Results The study enrolled 135 patients: 65.2% were males; the mean age was 56 years. 35.6% had unfavorable outcomes. In multivariate analysis, higher Sequential Organ Failure Assessment (SOFA) (p < 0.001), pre-existing hemiplegia (p = 0.049), and higher Charlson comorbidity index (CCI) (p = 0.028) were independently associated with unfavorable outcomes. Conclusions Higher SOFA, pre-existing hemiplegia and higher Charlson comorbidity index were significant risk factors for unfavorable clinical outcomes in patients with brain abscess.

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 MALNUTRITION, SEPSIS AND TUMOR LYSIS SYNDROME ARE ASSOCIATED WITH INCREASED RATE OF ACUTE MORTALITY IN MATURE B CELL NON-HODGKIN LYMPHOMA IN PEDIATRIC POPULATION- STUDY FROM TERTIARY CARE HOSPITAL IN PAKISTAN

2019 ◽  
Vol 11 (1) ◽  
pp. 02019043
Author(s):  
Raheela Mansoor
Keyword(s):  
Risk Factors ◽  
Fungal Infection ◽  
B Cell ◽  
Pediatric Population ◽  
Tertiary Care ◽  
Tumor Lysis Syndrome ◽  
Significant Risk ◽  
Early Death ◽  
Care Hospital ◽  
Tumor Lysis

Background:            Outcomes of pediatric mature B cell NHL in resource challenged countries are negatively affected by increased rate of early and toxic deaths. Aim of this study is to assess rate of acute mortality and define significant risk factors present in children with mature B Cell NHL. Methods: A retrospective analysis was done of patients with B cell NHL from January 2012 till December 2016. Risk factors studied for acute mortality were malnutrition, stage, prior surgery with open laparotomy, LDH levels, tumor lysis syndrome, sepsis and fungal infection Results: Total 233 patients were enrolled in the study. Eighty five (36.4%) were below 15th percentile.  Treatment was started in 226 patients. Eighty eight percent children showed 20% response after COP pre-phase. Tumor lysis syndrome was developed in 20.6 % (n = 48) children and 42.9% (n = 100) patients had sepsis, 71/100 patients had culture proven sepsis. 19.7% (n = 46) patients developed fungal infection. There was 19.7% (n = 46) acute mortality.  Most common cause of death was sepsis (n = 22, 47.8%) followed by acute renal failure secondary to tumor lysis syndrome. On multivariate analysis, three independent variables found significant for early death are malnutrition, sepsis and tumor lysis syndrome. Conclusion: Rate of acute mortality in B cell NHL is high in our set up and significant risk factors are tumor lysis syndrome, sepsis and malnourishment at time of presentation.

Challenging the Current Treatment Paradigm for Methicillin-Resistant Staphylococcus Epidermidis Peritonitis in Peritoneal Dialysis Patients

2002 ◽  
Vol 22 (3) ◽  
pp. 335-338 ◽  
Author(s):  
Robert E. Ariano ◽  
Christine Franczuk ◽  
Adrian Fine ◽  
Godfrey K.M. Harding ◽  
Sheryl A. Zelenitsky
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Staphylococcus Epidermidis ◽  
Methicillin Resistance ◽  
Tertiary Care ◽  
Significant Risk ◽  
Response Rates ◽  
Care Hospital ◽  
Clinical Failure ◽  
Empiric Treatment

Objectives To analyze clinical outcomes of Staphylococcus epidermidis peritoneal dialysis peritonitis before and after an interventional switch from a vancomycin/tobramycin to a cefazolin/tobramycin regimen for empiric treatment. To examine risk factors associated with clinical failure. Design A retrospective study. Setting A peritoneal dialysis program within a university-affiliated tertiary-care hospital. Patients 93 episodes of S. epidermidis peritonitis over a 6-year period. Interventions Clinical responses were compared between treatments using chi-square or Fisher's exact test. Univariate and multivariate analyses were used to identify significant risk factors for clinical failure. Measurements and Main Results There was no difference in the overall response rates observed with vancomycin (40/49; 81.6%) and cefazolin (23/29; 79.3%) regimens for episodes of S. epidermidis peritonitis. Furthermore, the presence of methicillin resistance in 63 of 93 cases (67.7%) had no influence on clinical outcome, with response rates of 83.9% (26/31) and 82.4% (14/17) for empiric vancomycin and cefazolin regimens, respectively. Tobramycin therapy of less than 2 days was an independent risk factor for clinical failure in multivariate logistic regression analysis (odds ratio 4.44, 95% confidence interval 1.28 – 15.48; p = 0.02). Conclusions Empiric treatment with intraperitoneal cefazolin was as effective as vancomycin for S. epidermidis peritonitis despite a high prevalence of methicillin resistance. Tobramycin therapy of less than 2 days was strongly associated with treatment failure.

scholarly journals Risk factors for and clinical outcomes of carbapenem non-susceptible gram negative bacilli bacteremia in patients with acute myelogenous leukemia

2020 ◽  
Author(s):  
Dong Hoon Shin ◽  
Dong-Yeop Shin ◽  
Chang Kyung Kang ◽  
Suhyeon Park ◽  
Jieun Park ◽  
...  
Keyword(s):  
Risk Factors ◽  
Clinical Outcomes ◽  
Acute Myelogenous Leukemia ◽  
Tertiary Care ◽  
Myelogenous Leukemia ◽  
Care Hospital ◽  
Gram Negative ◽  
Carbapenem Resistant ◽  
Appropriate Treatment ◽  
Acute Myelogenous

Abstract Background: Carbapenem is frequently used when gram negative bacilli (GNB) bacteremia is detected especially in neutropenic patients. Consequently, appropriate treatment could be delayed in GNB bacteremia cases involving organisms which are not susceptible to carbapenem (carba-NS), resulting in a poor clinical outcomes. Here, we explored risk factors for carba-NS GNB bacteremia and its clinical outcomes in patients with acute myelogenous leukemia (AML) that underwent chemotherapy. Methods: We reviewed all GNB bacteremia cases that occurred during induction or consolidation chemotherapy, over a 15-year period, in a tertiary-care hospital. Results: Among 489 GNB bacteremia cases from 324 patients, 45 (9.2%) were carba-NS and 444 (90.8%) were carbapenem susceptible GNB. Independent risk factors for carba-NS GNB bacteremia were: carbapenem use at bacteremia onset (adjusted odds ratio [aOR]: 91.2; 95% confidence interval [95%CI]: 29.3-284.1; P<0.001); isolation of carbapenem-resistant Acinetobacter baumannii (aOR: 19.4, 95%CI: 3.4-112.5; P=0.001) in the prior year; and days from chemotherapy to GNB bacteremia (aOR: 1.1 per day, 95%CI: 1.1-1.2; P<0.001). Carba-NS bacteremia was independently associated with in-hospital mortality (aOR: 6.6, 95%CI: 3.0-14.8; P<0.001). Conslusion: Carba-NS organisms should be considered for antibiotic selection in AML patients having these risk factors.

scholarly journals agrDysfunction Affects Staphylococcal Cassette ChromosomemecType-Dependent Clinical Outcomes in Methicillin-Resistant Staphylococcus aureus Bacteremia

2015 ◽  
Vol 59 (6) ◽  
pp. 3125-3132 ◽  
Author(s):  
Chang Kyung Kang ◽  
Jeong Eun Cho ◽  
Yoon Jeong Choi ◽  
Younghee Jung ◽  
Nak-Hyun Kim ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
South Korea ◽  
Clinical Outcomes ◽  
Tertiary Care ◽  
High Rate ◽  
Care Hospital ◽  
Virulence Determinants ◽  
Methicillin Resistant ◽  
Content Type ◽  
Type Iv

ABSTRACTStaphylococcal cassette chromosomemecelement (SCCmec) type-dependent clinical outcomes may vary due to geographical variation in the presence of virulence determinants. We compared the microbiological factors and mortality attributed to methicillin-resistantStaphylococcus aureus(MRSA) bacteremia between SCCmectypes II/III and type IV. All episodes of MRSA bacteremia in a tertiary-care hospital (South Korea) over a 4.5-year period were reviewed. We studied the microbiological factors associated with all blood MRSA isolates, includingspatype,agrtype,agrdysfunction, and the genes for Panton-Valentine leukocidin (PVL) and phenol-soluble modulin (PSM)-mec, in addition to SCCmectype. Of 195 cases, 137 involved SCCmectypes II/III, and 58 involved type IV. The mortality attributed to MRSA bacteremia was less frequent among the SCCmectype IV (5/58) than that among types II/III (39/137,P= 0.002). This difference remained significant when adjusted for clinical factors (adjusted odds ratio [aOR], 0.14; 95% confidence interval [CI], 0.04 to 0.49;P= 0.002). Of the microbiological factors tested,agrdysfunction was the only significant factor that showed different positivity between the SCCmectypes, and it was independently associated with MRSA bacteremia-attributed mortality (aOR, 4.71; 95% CI, 1.72 to 12.92;P= 0.003). SCCmectype IV is associated with lower MRSA bacteremia-attributed mortality than are types II/III, which might be explained by the high rate ofagrdysfunction in SCCmectypes II/III in South Korea.

scholarly journals Prevalence and Risk Factors of Metallo β-lactamase Producing Pseudomonas aeruginosa and Acinetobacter species in Burns and Surgical Wards in a Tertiary Care Hospital

2012 ◽  
Vol 4 (01) ◽  
pp. 039-042 ◽  
Author(s):  
Simit H Kumar ◽  
Anuradha S De ◽  
Sujata M Baveja ◽  
Madhuri A Gore
Keyword(s):  
Risk Factors ◽  
Pseudomonas Aeruginosa ◽  
Tertiary Care ◽  
Significant Risk ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Resistance Mechanisms ◽  
Care Hospital ◽  
Acinetobacter Species ◽  
Carbapenem Resistant

ABSTRACT Introduction: The production of Metallo-β-lactamases (MBLs) is one of the resistance mechanisms of Pseudomonas aeruginosa and Acinetobacter species. There is not much Indian data on the prevalence of MBLs in burns and surgical wards. Materials and Methods: A total of 145 non-duplicate isolates of carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter species, isolated from pus/wound swabs and endotracheal secretions from burns and surgical wards, were tested for MBL production by modified ethylene diamine tetra acetic acid (EDTA) disc synergy and double disc synergy tests. Results: Prevalence of MBLs was 26.9% by both the above tests. All MBL-positive isolates were multidrug resistant. Only 6.06% (2/33) P.aeruginosa and 16.67% (1/06) Acinetobacter species were susceptible to piperacillin-tazobactam and netilmycin, respectively. These patients had multiple risk factors like >8 days hospital stay, catheterization, IV lines, previous antibiotic use, mechanical ventilation, etc. Graft application and surgical intervention were significant risk factors in MBL-positive patients. Overall mortality in MBL-positive patients was 34.21%. Conclusion: Emergence of MBL-producing Pseudomonas aeruginosa and Acinetobacter species in this hospital is alarming, which reflect excessive use of carbapenems and at the same time, pose a therapeutic challenge to clinicians as well as to microbiologists. Therefore, a strict antibiotic policy and implementation of proper infection control practices will go a long way to prevent further spread of MBLs. Detection of MBLs should also become mandatory in all hospitals.

scholarly journals Sex differences in clinical presentation in acute MI

2017 ◽  
Vol 4 (4) ◽  
pp. 940
Author(s):  
Ashwin Kodliwadmath ◽  
Naren V. Nimbal
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Chest Pain ◽  
Clinical Presentation ◽  
Tertiary Care ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Control Group ◽  
Care Hospital ◽  
Acute Mi

Background: Acute myocardial infarction differs in women and men with respect to risk factors and clinical presentation. There are studies carried out worldwide on this issue but few from India. This study was done to study the sex based differences in the risk factors and clinical features of acute MI in patients with Indian ethnicity.Methods: Comparative prospective study consisting of 100 women as study group and 100 men as control group with acute MI, who were admitted in a tertiary care hospital, from December 2016 to June 2017.Results: Chest pain was the main complaint in majority of the women (82%) and men (88%). Radiation of chest pain (87%) and sweating (90%) were significantly present in men compared to women (65% and 62% respectively), while breathlessness was significantly present in women (78%) compared to men (64%) and fatigue in women (76%) significantly more than men (55%). Smoking was a significant risk factor in men (69%) compared to women (5%), while diabetes mellitus was a significant risk factor in women (62%) compared to men (39%).Conclusions: Women with acute MI had more atypical presentation of symptoms, similar risk factors, compared to men except for smoking which was more significant in men and diabetes more common in women.

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