Infectious diseases specialist consultation in Staphylococcus lugdunensis bacteremia

Background Commensal coagulase negative Staphylococcus lugdunensis may cause severe bacteremia (SLB) and complications. Treatment of SLB is not fully established and we wanted to evaluate if infectious diseases specialist consultation (IDSC) would improve management and prognosis. Methods Multicenter retrospective study of SLB patients followed for 1 year. Patients were stratified according to bedside (formal), telephone (informal) or lack of IDSC within 7 days of SLB diagnosis. Results Altogether, 104 SLB patients were identified: 24% received formal bedside and 52% informal telephone IDSC whereas 24% were managed without any IDSC. No differences in demographics, underlying conditions or severity of illness were observed between the groups. Patients with bedside IDSC, compared to telephone IDSC or lack of IDSC, had transthoracic echocardiography more often performed (odds ratio [OR] 4.00; 95% confidence interval [CI] 1.31–12.2; p = 0.012) and (OR 16.0; 95% CI, 4.00–63.9; P<0.001). Bedside IDSC was associated with more deep infections diagnosed compared to telephone IDSC (OR, 7.44; 95% CI, 2.58–21.4; p<0.001) or lack of IDSC (OR, 9.56; 95% CI, 2.43–37.7; p = 0.001). The overall mortality was 7%, 10% and 17% at 28 days, 90 days and 1 year, respectively. Considering all prognostic parameters, patients with IDSC, compared to lack of IDSC, had lower 90 days and 1 year mortality (OR, 0.11; 95% CI, 0.02–0.51; p = 0.005) and (OR, 0.22; 95% CI, 0.07–0.67; p = 0.007). Conclusion IDSC may improve management and outcome of Staphylococcus lugdunensis bacteremia.

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Association between hydroxocobalamin administration and acute kidney injury after smoke inhalation: a multicenter retrospective study

Critical Care ◽

10.1186/s13054-019-2706-0 ◽

2019 ◽

Vol 23 (1) ◽

Cited By ~ 1

Author(s):

François Dépret ◽

Clément Hoffmann ◽

Laura Daoud ◽

Camille Thieffry ◽

Laure Monplaisir ◽

...

Keyword(s):

Acute Kidney Injury ◽

Retrospective Study ◽

Confidence Interval ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Kidney Injury ◽

Smoke Inhalation ◽

Logistic Regression Models ◽

Increased Risk ◽

The Impact

Abstract Background The use of hydroxocobalamin has long been advocated for treating suspected cyanide poisoning after smoke inhalation. Intravenous hydroxocobalamin has however been shown to cause oxalate nephropathy in a single-center study. The impact of hydroxocobalamin on the risk of acute kidney injury (AKI) and survival after smoke inhalation in a multicenter setting remains unexplored. Methods We conducted a multicenter retrospective study in 21 intensive care units (ICUs) in France. We included patients admitted to an ICU for smoke inhalation between January 2011 and December 2017. We excluded patients discharged at home alive within 24 h of admission. We assessed the risk of AKI (primary endpoint), severe AKI, major adverse kidney (MAKE) events, and survival (secondary endpoints) after administration of hydroxocobalamin using logistic regression models. Results Among 854 patients screened, 739 patients were included. Three hundred six and 386 (55.2%) patients received hydroxocobalamin. Mortality in ICU was 32.9% (n = 243). Two hundred eighty-eight (39%) patients developed AKI, including 186 (25.2%) who developed severe AKI during the first week. Patients who received hydroxocobalamin were more severe and had higher mortality (38.1% vs 27.2%, p = 0.0022). The adjusted odds ratio (95% confidence interval) of AKI after intravenous hydroxocobalamin was 1.597 (1.055, 2.419) and 1.772 (1.137, 2.762) for severe AKI; intravenous hydroxocobalamin was not associated with survival or MAKE with an adjusted odds ratio (95% confidence interval) of 1.114 (0.691, 1.797) and 0.784 (0.456, 1.349) respectively. Conclusion Hydroxocobalamin was associated with an increased risk of AKI and severe AKI but was not associated with survival after smoke inhalation. Trial registration ClinicalTrials.gov, NCT03558646

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Treatment with Epinephrine (Adrenaline) in Suspected Anaphylaxis during Anesthesia in Denmark

Anesthesiology ◽

10.1097/aln.0b013e318218119d ◽

2011 ◽

Vol 115 (1) ◽

pp. 111-116 ◽

Cited By ~ 37

Author(s):

Lene H. Garvey ◽

Bo Belhage ◽

Mogens Krøigaard ◽

Bent Husum ◽

Hans-Jørgen Malling ◽

...

Keyword(s):

Cardiac Arrest ◽

Retrospective Study ◽

Confidence Interval ◽

Median Time ◽

Odds Ratio ◽

Anaphylactic Shock ◽

Route Of Administration ◽

Epinephrine Administration ◽

Timing Of Treatment

Background Literature on the use of epinephrine in the treatment of anaphylaxis during anesthesia is very limited. The objective of this study was to investigate how often epinephrine is used in the treatment of suspected anaphylaxis during anesthesia in Denmark and whether timing of treatment is important. Methods A retrospective study of 270 patients investigated at the Danish Anaesthesia Allergy Centre after referral due to suspected anaphylaxis during anesthesia was performed. Reactions had been graded by severity: C1, mild reactions; C2, moderate reactions; C3, anaphylactic shock with circulatory instability; C4, cardiac arrest. Use of epinephrine, dosage, route of administration, and time between onset of circulatory instability and epinephrine administration were noted. Results A total of 122 (45.2%) of referred patients had C3 or C4 reactions; of those, 101 (82.8%) received epinephrine. Route of administration was intravenous in 95 (94%) patients. Median time from onset of reported hypotension to treatment with epinephrine was 10 min (range, 1-70 min). Defining epinephrine treatment less than or equal to 10 min after onset of hypotension as early, and more than 10 min as late, infusion was needed in 12 of 60 patients (20%) treated early versus 12 of 35 patients (34%) treated late (odds ratio, 2.09) (95% confidence interval, 0.81-5.35). Conclusion Anaphylaxis may be difficult to diagnose during anesthesia, and treatment with epinephrine can be delayed as a consequence. Anaphylaxis should be considered and treated in patients with circulatory instability during anesthesia of no apparent cause who do not respond to the usual treatments.

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Impact of a Formal Lactation Curriculum for Residents on Breastfeeding Rates Among Low-Income Women

The Journal of Perinatal Education ◽

10.1891/j-pe-d-18-00018 ◽

2020 ◽

Vol 29 (2) ◽

pp. 83-89

Author(s):

Emma Qureshey ◽

Adetola F. Louis-Jacques ◽

Yasir Abunamous ◽

Sandra Curet ◽

Joanne Quinones

Keyword(s):

Retrospective Study ◽

Confidence Interval ◽

Low Income ◽

Medical Records ◽

Odds Ratio ◽

Curriculum Implementation ◽

Demographic Information ◽

Before And After ◽

Breastfeeding Rates ◽

The Impact

Obstetrics-gynecology residents have inadequate training in lactation management and are typically unable to address basic breastfeeding needs. A retrospective study was performed to evaluate the impact of a formal lactation curriculum for obstetrics-gynecology residents on breastfeeding. Demographic information, medical history, and breastfeeding rates were derived from medical records and hospital lactation logs. Breastfeeding outcomes of women with term, singleton infants were analyzed before and after curriculum implementation. The study included 717 women, 337 prior to intervention and 380 after intervention. Women who delivered after curriculum implementation were more likely to breastfeed exclusively at 6 weeks postpartum (odds ratio [OR]: 2.01; 95% confidence interval [CI]: 1.28–3.15). A targeted breastfeeding curriculum was associated with increased exclusive breastfeeding rates at 6 weeks postpartum in a diverse, low-income population.

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Association of a Remotely Offered Infectious Diseases eConsult Service With Improved Clinical Outcomes

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa003 ◽

2020 ◽

Vol 7 (1) ◽

Cited By ~ 6

Author(s):

Aaron J Tande ◽

Elie F Berbari ◽

Priya Ramar ◽

Shiva P Ponamgi ◽

Umesh Sharma ◽

...

Keyword(s):

Confidence Interval ◽

Infectious Diseases ◽

Health System ◽

Clinical Outcomes ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Case Control Study ◽

Case Control ◽

Consultative Service ◽

Control Study

Abstract We performed a case–control study to evaluate an electronic, asynchronous infectious diseases consultative service at 2 rural hospitals within our health system. Patients with consultation via this platform (n = 100) had a significantly decreased odds of death at 30 days compared with propensity-matched controls (n = 300; adjusted odds ratio, 0.3; 95% confidence interval, 0.2–0.7; P = .003).

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Clinical Features and Risk Factors for Mortality in Hospitalized Older Adults with Pneumonia

Canadian Respiratory Journal ◽

10.1155/2021/5644824 ◽

2021 ◽

Vol 2021 ◽

pp. 1-6

Author(s):

Nobuhiko Fukuda ◽

Nobuaki Kobayashi ◽

Makoto Masuda ◽

Aya Wakabayashi ◽

Nobuko Kusano ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Risk Factor ◽

Retrospective Study ◽

Confidence Interval ◽

Clinical Features ◽

Odds Ratio ◽

Pneumococcal Vaccination ◽

Small Sample ◽

City Hospital

Background. Pneumonia is a common disease among the aging population in Japan. Hence, it is important to elucidate the risks related to pneumonia mortality. Since Streptococcus pneumoniae is the most commonly observed pathogen, pneumococcal vaccination is recommended to older adults. Therefore, this study aimed to clarify the clinical features of pneumonia, including the status of pneumococcal vaccination, in hospitalized older adult patients in Japan. Methods. This single-centered retrospective study was conducted by reviewing the medical records of all patients with acute pneumonia at Fujisawa City Hospital in Japan from April 2018 to March 2019. Patients were divided into two groups based on their history of pneumococcal vaccination. The primary endpoint was in-hospital mortality, while the secondary endpoint was risk factors associated with mortality. Results. We included 93 patients with pneumonia in this retrospective study. Although the mortality rate was higher in the vaccinated group (15.8%) than in the unvaccinated group (9.1%), vaccination status was not identified as a significant risk factor for mortality after multivariable logistic regression (odds ratio: 2.71; 95% confidence interval: 0.667–11.02; p = 0.16 ). In addition, the A-DROP score was identified as an independent risk factor (odds ratio: 2.64; 95% confidence interval: 1.22–5.72; p = 0.008 ). Conclusions. Our study suggested that the A-DROP score is a risk factor of mortality for pneumonia in older adults. In addition, pneumococcal vaccination history was related to increased mortality; however, the influence of the vaccination remains unclear because of the small sample size.

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Diagnostic accuracy of (1→3)-β-D-glucan to predict Pneumocystis jirovecii pneumonia in non-HIV-infected patients

Radiology and Oncology ◽

10.2478/raon-2020-0028 ◽

2020 ◽

Vol 54 (2) ◽

pp. 221-226

Author(s):

Petra Rogina ◽

Miha Skvarc

Keyword(s):

Retrospective Study ◽

Confidence Interval ◽

Odds Ratio ◽

Lower Respiratory Tract ◽

Pneumocystis Jirovecii ◽

Cape Cod ◽

Direct Immunofluorescence ◽

Pneumocystis Jirovecii Pneumonia ◽

Radiological Findings ◽

Serum Samples

AbstractBackgroundPneumocystis jirovecii pneumonia (PCP) is a common and potentially fatal opportunistic infection in immunocompromised non-HIV individuals. There are problems with clinical and diagnostic protocols for PCP that lack sensitivity and specificity. We designed a retrospective study to compared several methods that were used in diagnostics of PCP.Patients and methodsOne hundred and eight immunocompromised individuals with typical clinical picture for PCP and suspicious radiological findings were included in the study. Serum samples were taken to measure the values of (1→3)-β-D-glucan (Fungitell, Associates of Cape Cod, USA). Lower respiratory tract samples were obtained to perform direct immunofluorescence (DIF, MERIFLUOR® Pneumocystis, Meridian, USA) stain and real-time PCR (qPCR).ResultsFifty-four (50%) of the 108 patients in our study had (1→3)-β-D-glucan > 500 pg/ml. Patients that had (1→3)-β-D-glucan concentrations < 400 pg/ml in serum, had mean threshold cycles (Ct) 35.43 ± 3.32 versus those that had (1→3)-β-D-glucan concentrations >400 pg/mL and mean Ct of 28.97 ± 5.27 (P < 0.001). If we detected P. jirovecii with DIF and qPCR than PCP was proven. If the concentration of (1→3)-β-D-glucan was higher than 400 pg/ml and Ct of qPCR was below 28.97 ± 5.27 than we have been able be certain that P. jirovecii caused pneumonia (odds ratio [OR] 2.31, 95% confidence interval [CI] 1.62–3.27, P < 0.001).ConclusionsMeasurement of (1→3)-β-D-glucan or qPCR alone could not be used to diagnose PCP. Diagnostic cut-off value for (1→3)-β-D-glucan > 400pg/ml and qPCR below 30 Ct, allow us to conclude that patient has PCP. If the values of (1→3)-β-D-glucan are < 400 pg/ml and qPCR is above 35 Ct than colonization with P. jirovecii is more possible than PCP.

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Longer Diagnosis-surgery Duration Is Associated With an Increased Risk of Early Postoperative Complications for Crohn's Disease: A Retrospective Study

10.21203/rs.3.rs-1142302/v1 ◽

2021 ◽

Author(s):

Xuanyi Chen ◽

Siqi Zhang ◽

Fanru Shen ◽

Yuan Shi ◽

Sailiang Liu ◽

...

Keyword(s):

Risk Factors ◽

Platelet Count ◽

Crohn’S Disease ◽

Retrospective Study ◽

Crohn's Disease ◽

Confidence Interval ◽

Odds Ratio ◽

Early Postoperative Complications ◽

Increased Risk ◽

Surgery Duration

Abstract Background: Early postoperative complications(ePOCs) frequently occur in Crohn’s patients after surgery. The risk factors of ePOCs for Crohn’s disease (CD), however, remain controversial. We aimed to assess the incidence and risk factors of ePOCs in CD patients after surgical resection.Methods: The retrospective study was conducted on 97 patients undergoing surgeries between January 2010 and September 2019 for Crohn’s disease in a tertiary hospital in China. Results: In total, 33 patients (34.0%) experienced ePOCs, including 11 intra-abdominal septic complications (11.3%) and 1 postoperative death (1.0%). Severe complications (Dindo–Clavien III–IV) were seen in 8 patients (8.2%). In multivariate analysis, diagnosis-surgery duration exceeding 6 months(odds-ratio [OR]=4.07; confidence interval [CI] 95%[1.10-15.09], P=0.036), serum platelet count <300*1000/mm3(odds-ratio [OR]=6.74; confidence interval [CI] 95%[1.58-28.71], P=0.01) and serum gamma-glutamyl transpeptidase(GGT) level >10U/L(odds-ratio [OR]=9.22; confidence interval [CI] 95%[1.23-68.99], P=0.031)were identified as independent risk factors for ePOCs. Preoperative exposure to anti-tumor necrosis factor (TNF) agents (P=1.00) were not associated with a higher risk of ePOCs. 34.0% of CD patients developed ePOCs after surgical resection.Conclusions: Diagnosis-surgery duration exceeding 6 months, serum platelet count <300*1000/mm3, and serum GGT level >10U/L were associated with an increased risk of ePOCs. Preoperative exposure to anti-TNF agents were not associated with a higher risk of ePOCs.

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Drug-related problem and its predictors among pediatric patients with infectious diseases admitted to Jimma University Medical Center, Southwest Ethiopia: Prospective observational study

SAGE Open Medicine ◽

10.1177/2050312120970734 ◽

2020 ◽

Vol 8 ◽

pp. 205031212097073

Author(s):

Desalegn Feyissa Mechessa ◽

Dula Dessalegn ◽

Tsegaye Melaku

Keyword(s):

Confidence Interval ◽

Infectious Diseases ◽

Odds Ratio ◽

Prediction of duration of psychosis before first admission

European Psychiatry ◽

10.1016/s0924-9338(99)80701-9 ◽

1998 ◽

Vol 13 (7) ◽

pp. 346-352 ◽

Cited By ~ 51

Author(s):

H Verdoux ◽

C Bergey ◽

F Assens ◽

F Abalan ◽

B Gonzales ◽

...

Keyword(s):

Family History ◽

Confidence Interval ◽

Educational Level ◽

Odds Ratio ◽

Poor Prognosis ◽

Severity Of Illness ◽

Psychotic Symptoms ◽

Duration Of Untreated Psychosis ◽

History Of ◽

First Admission

SummaryObjective:To assess the factors predicting the delay between onset of psychotic symptoms and first admission in a populationbased sample.Method:The duration of psychosis before admission was ascertained in a standardised way for 59 consecutively first-admitted patients presenting with psychotic symptoms.Results:The median of the duration of psychosis before admission was 3 months (interquartile range 0.5-14). A delay ≥ 3 months was independently predicted by family history of psychiatric hospitalisation (odds ratio [OR] = 12.1, 95% confidence interval [CI] 1.15-97.0, P = 0.02). low educational level (OR = 7.7, 95% CI 1.0-50.0, P = 0.05), poor global adjustment in the preceding year (OR = 0.93, 95% CI 0.860.99, P = 0.04). and by greater global severity of illness at admission (OR = 4.0, 95% CI 0.87-18.3, P = 0.07).Conclusion:As these factors are also known to predict poor outcome, our results suggest that the association between duration of untreated psychosis and poor prognosis may be mediated, at least in part, by such demographic and clinical variables.

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Endograft type and anesthesia mode are associated with mortality of endovascular aneurysm repair for ruptured abdominal aortic aneurysms

Vascular ◽

10.1177/1708538120947859 ◽

2020 ◽

pp. 170853812094785

Author(s):

Kirthi S Bellamkonda ◽

Sameh Yousef ◽

Yawei Zhang ◽

Alan Dardik ◽

Arnar Geirsson ◽

...

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Confidence Interval ◽

Odds Ratio ◽

Endovascular Aneurysm Repair ◽

Infrarenal Abdominal Aortic Aneurysm ◽

Abdominal Aortic ◽

Significant Difference ◽

Aneurysm Repair ◽

Overall Mortality

Objective Endovascular aneurysm repair has become the primary treatment modality for ruptured infrarenal abdominal aortic aneurysm. This study examines the impact of endograft type on perioperative outcomes for ruptured infrarenal abdominal aortic aneurysm. Method The targeted endovascular aneurysm repair files of the American College of Surgeons National Surgical Quality Improvement Program database (2012–2017) were used. Only patients treated for ruptured infrarenal abdominal aortic aneurysm were included. All patients requiring concomitant stenting of the visceral arteries or aneurysmal iliac arteries or open abdominal surgery were excluded. The characteristics of patients treated with the different endografts and the corresponding outcomes were compared using Stata software. Results There were 479 patients treated with the three most common endografts: Cook Zenith ( n = 127), Gore Excluder ( n = 239), and Medtronic Endurant ( n = 113). The number of other endografts was too small for statistical analysis. Compared to patients treated with Excluder or Endurant, the patients treated with Zenith had significantly lower body mass index ( P < .001) and were less likely to be white ( P < .001). On the other hand, patients treated with Endurant were less likely to be smoker ( P = .016). Patients treated with Zenith had significantly larger ruptured infrarenal abdominal aortic aneurysm diameter ( P = .045). The overall mortality was 18% and morbidity 74.3%. There was a statistically significant difference in overall mortality (Zenith = 11.8%, Excluder = 18%, Endurant = 24.8%, P = .033) but not morbidity ( P = .808) between the three groups. Post hoc analysis for overall mortality showed only significant difference between Zenith and Endurant. The difference in mortality was not significant in patients presenting with ruptured infrarenal abdominal aortic aneurysm without hypotension ( P = .065). On multivariable analysis, treatment with the Endurant endograft was associated with increased mortality compared to Zenith (odds ratio = 3.0 [confidence interval 1.31–6.7]). General anesthesia (odds ratio = 2.67 [confidence interval 1.02–7.02]), rupture with hypotension (odds ratio = 4.49 [confidence interval 2.54–7.95]), and dependent functional status (odds ratio = 5.7 [confidence interval 1.96–16.59]) were independently associated with increased mortality while increasing body mass index (odds ratio = 0.97 [confidence interval 0.95–0.99]) was associated with reduced risk of mortality. Conclusions This study highlights contemporary outcomes of endovascular aneurysm repair for ruptured infrarenal abdominal aortic aneurysm with relatively low mortality. Endograft type and anesthesia technique are modifiable factors that can potentially improve outcomes. Significant variation in the outcomes of the different endografts warrants further research.

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