scholarly journals Risk factors for death in patients with severe asthma

2014 ◽  
Vol 40 (4) ◽  
pp. 364-372 ◽  
Author(s):  
Andréia Guedes Oliva Fernandes ◽  
Carolina Souza-Machado ◽  
Renata Conceição Pereira Coelho ◽  
Priscila Abreu Franco ◽  
Renata Miranda Esquivel ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Asthma Control ◽  
Severe Asthma ◽  
Airflow Obstruction ◽  
Care Facility ◽  
Health Care Facility ◽  
Control Program ◽  
Male Gender ◽  
Respiratory Causes

OBJECTIVE: To identify risk factors for death among patients with severe asthma. METHODS: This was a nested case-control study. Among the patients with severe asthma treated between December of 2002 and December of 2010 at the Central Referral Outpatient Clinic of the Bahia State Asthma Control Program, in the city of Salvador, Brazil, we selected all those who died, as well as selecting other patients with severe asthma to be used as controls (at a ratio of 1:4). Data were collected from the medical charts of the patients, home visit reports, and death certificates. RESULTS: We selected 58 cases of deaths and 232 control cases. Most of the deaths were attributed to respiratory causes and occurred within a health care facility. Advanced age, unemployment, rhinitis, symptoms of gastroesophageal reflux disease, long-standing asthma, and persistent airflow obstruction were common features in both groups. Multivariate analysis showed that male gender, FEV1 pre-bronchodilator < 60% of predicted, and the lack of control of asthma symptoms were significantly and independently associated with mortality in this sample of patients with severe asthma. CONCLUSIONS: In this cohort of outpatients with severe asthma, the deaths occurred predominantly due to respiratory causes and within a health care facility. Lack of asthma control and male gender were risk factors for mortality.

Risk Factors for Atherothrombotic Brain Infarction in Persons Over 62 Years of Age in a Long-Term Health Care Facility

1987 ◽  
Vol 35 (1) ◽  
pp. 1-3 ◽  
Author(s):  
Wilbert S. Aronow ◽  
Laurence Starling ◽  
Fritzner Etienne ◽  
Peter D'Alba ◽  
Mildred Edwards ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Brain Infarction ◽  
Care Facility ◽  
Health Care Facility

scholarly journals Risk Factors for Development of Carbapenem Resistance Among Gram-Negative Rods

2019 ◽  
Vol 6 (3) ◽  
Author(s):  
Stefan E Richter ◽  
Loren Miller ◽  
Jack Needleman ◽  
Daniel Z Uslan ◽  
Douglas Bell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Carbapenem Resistance ◽  
High Morbidity ◽  
Index Hospitalization ◽  
Hospital System ◽  
Gram Negative ◽  
C Statistic

Abstract Background Infections due to carbapenem-resistant Gram-negative rods (CR-GNR) are increasing in frequency and result in high morbidity and mortality. Appropriate initial antibiotic therapy is necessary to reduce adverse consequences and shorten length of stay. Methods To determine risk factors for recovery on culture of CR-GNR, cases were retrospectively analyzed at a major academic hospital system from 2011 to 2016. Ertapenem resistance (ER-GNR) and antipseudomonal (nonertapenem) carbapenem resistance (ACR-GNR) patterns were analyzed separately. A total of 30951 GNR isolates from 12370 patients were analyzed, 563 of which were ER and 1307 of which were ACR. Results In multivariate analysis, risk factors for ER-GNR were renal disease, admission from another health care facility, ventilation at any point before culture during the index hospitalization, receipt of any carbapenem in the prior 30 days, and receipt of any anti-methicillin-resistant Staphylococcus aureus (anti-MRSA) agent in the prior 30 days (c-statistic, 0.74). Risk factors for ACR-GNR were male sex, admission from another health care facility, ventilation at any point before culture during the index hospitalization, receipt of any carbapenem in the prior 30 days, and receipt of any anti-MRSA agent in the prior 30 days (c-statistic, 0.76). Conclusions A straightforward scoring system derived from these models can be applied by providers to guide empiric antimicrobial therapy; it outperformed use of a standard hospital antibiogram in predicting infections with ER-GNR and ACR-GNR.

scholarly journals Determinants of Categories of TB Retreatment with Special Reference to Sources of Primary Anti-TB Treatment

2020 ◽  
Vol 10 (03) ◽  
pp. 116-121
Author(s):  
Veerabadran Karthikeyan ◽  
Kalaiselvan Ganapathy
Keyword(s):  
Health Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Control Program ◽  
Health Care Facilities ◽  
Private Health Care ◽  
Tb Control ◽  
Care Facilities ◽  
Previously Treated ◽  
Tb Control Program

Abstract Introduction Retreatment (previously treated) cases are the tuberculosis (TB) patients who have been treated previously with anti-TB drugs for at least a month and who have now been registered for category II anti-TB therapy. Retreatment cases arise due to inadequate and improper treatment of the new TB cases. Objective The aim of the study is to assess the information regarding sources of previous TB drug exposure and treatment practices leading to retreatment cases (category II) and determinants leading to retreatment. Material and Methods It was a community-based cross-sectional study of patients registered as retreatment TB cases under revised national TB control program (RNTCP) in the TB unit of Puducherry between October 2013 and September 2014. The study was held between October 2013 and October 2015. Initially the quantitative data were collected and followed by qualitative data. Data were collected by interviewing the patients using a predesigned questionnaire. Data were entered and analyzed by using Epi Info (Version 3.4.3) software package. Results Out of the 193 study participants, relapse cases were the most common 50.8%, followed by treatment after default cases 23.8%, failure cases 11.9%, and retreatment others 13.5%. There is a significant association between the retreatment categories such as failure, TAD (treatment after default), retreatment others, and ever usage of tobacco (p < 0.05). There is also a significant association between the retreatment categories such as TAD, retreatment others, and ever usage of alcohol (p < 0.05). The sources of previous antitubercular therapy for 90.16% retreatment cases were from government health care facilities under RNTCP, whereas for 9.84% retreatment cases the sources of previous antitubercular treatment were private health care facilities. There is a significant association between public health care facility where patients were previously treated for TB and relapse (p = 0.001) and private health care facility where patients were previously treated for TB and TAD (p = 0.008). Conclusion As 90% of the patients have utilized the government health services for treatment, it shows the effective functioning of RNTCP-STF (state task force-revised national TB control program) mechanism in Puducherry.

scholarly journals Risk Factors and Clinical Outcomes of Cancer Patients with Clostridium difficile Associated Diarrhea Co-infected with a Second Enteropathogen

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S362-S363
Author(s):  
Harika Yalamanchili ◽  
Andrew Chao ◽  
Eduardo Yepez Guevara ◽  
Samuel L Aitken ◽  
Micah Bhatti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Cancer Patients ◽  
Clinical Symptoms ◽  
Care Facility ◽  
Health Care Facility ◽  
Exact Test ◽  
Increased Risk ◽  
Clostridium Difficile Associated Diarrhea ◽  
The Impact

Abstract Background Cancer patients are at an increased risk for C. difficile infection (CDI) which is often identified along with other enteropathogens. The impact of co-infections on outcomes has not been established in this population. We compared the risk factors and clinical characteristics of patients with CDI monoinfection (CDIM) and patients coinfected with bacterial (CDIB) or viral (CDIV) enteropathogens. Methods Adult patients presenting with primary or recurrent CDI (n = 88) identified on a two-step GI multiplex assay (Biofire) followed by toxin A/B EIA, were classified into CDIM (n = 66), CDIB (n = 12), and CDIV (n = 10) groups. Demographic and clinical data were collected and risk factors and outcomes compared by Fisher’s exact test, ANOVA, and the Kruskal–Wallis test. CDI severity was determined using Zar’s criteria, presence of bacteremia, and ICU stay. Results During the study period, 2,017 diarrheal samples were submitted to the microbiology laboratory. An enteric pathogen was identified in 311 (15%) patients. CDI was identified in 88 cases of which 22 (25%) had a second pathogen. CDIM was found in 66 (21%), CDIB in 12 (4%), and CDIV in 10 (3%) subjects. The most common co-pathogens identified were diarrheagenic E. coli in the CDIB group (9/12, 75%) and norovirus in the CDIV group (8/10, 80%). Groups were similar in terms of demographics, number of recurrences, health care acquisition, co-morbidities, disease severity, serum creatinine at presentation, presence of toxin by EIA, and mortality. Patients with CDIM were more likely to have a recent hospitalization than the CDIB group (44/66 67% vs.. 3/12 25%, P = 0.01). Clinical symptoms at presentation were similar for the three groups except for nausea which was more common in the CDIV group when compared with CDIM (8/10, 80% vs. 25/66, 38%; P = 0.02). The use of proton pump inhibitors was similar in the three groups. There was however, a higher proportion of patients taking GABA-like drugs within 90 days among the CDIB patients (10/12, 83%) than the group with CDIM (26/66, 40%) P = 0.01. Conclusion In CDI cancer patients, co-infection with other enteropathogens is common. Patients with CDIB were less likely to have a recent admission to a health care facility. The use of GABA-like drugs was associated with a higher risk of bacterial co-infection. Disclosures All authors: No reported disclosures.

Risk factors for coronary artery disease in persons older than 62 years in a long-term health care facility

1986 ◽  
Vol 57 (8) ◽  
pp. 518-520 ◽  
Author(s):  
Wilbert S. Aronow ◽  
Laurence Starling ◽  
Fritzner Etienne ◽  
Peter D'Alba ◽  
Mildred Edwards ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Health Care ◽  
Coronary Artery ◽  
Care Facility ◽  
Health Care Facility ◽  
Artery Disease

scholarly journals Epidemiological Risk Factors for Acquiring Severe COVID-19: Prospective Cohort Study

2021 ◽  
Vol 36 (5) ◽  
pp. e301-e301
Author(s):  
Salah T. Al Awaidy ◽  
Faryal Khamis ◽  
Ozayr Mahomed ◽  
Ronald Wesonga ◽  
Muna Al Shuabi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Cohort Study ◽  
High Risk ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Care Facility ◽  
Health Care Facility ◽  
Factors Associated ◽  
Epidemiological Risk

Objectives: We aimed to determine epidemiological risk factors associated with acquiring severe coronavirus disease 2019 (COVID-19) in patients requiring hospitalization. Methods: A prospective cohort study was conducted using a questionnaire comprised of six closed-ended questions to identify potential risk factors for severe COVID-19. Using COVID-19 associated illnesses and complications (pneumonia, acute respiratory distress syndrome, need for mechanical ventilation, acute kidney failure, cardiac failure, and thromboembolic events), we derived an index variable to measure the severity of COVID-19 in patients. Results: We included 143 adult patients with confirmed COVID-19 of whom 62.2% (n = 89) were male and 37.8% (n = 54) were female. The average age of the cohort was 50.6±16.5 years. Our study found that being a female, working at the health care facility, being a healthcare worker, attending a mass gathering within the last 14 days, attending a gathering with 10 persons or less, and being admitted to a hospital were associated with increased risk of developing severe COVID-19. The only risk factor associated with severe COVID-19 was working at a health care facility (odds ratio = 33.42, p =0.029). Conclusions: Intervention directed to control risk factors associated with acquiring severe COVID-19 should be a core priority for all countries, especially among high-risk occupations and workplaces, including working at a health care facility. A risk-based approach to prioritize vaccination among these high-risk individuals should be supported to strengthen the implementation of non-pharmaceutical interventions.

scholarly journals Using Patient Risk Factors to Identify Whether Carbapenem-Resistant Enterobacteriaceae Infections Are Caused by Carbapenemase-Producing Organisms

2018 ◽  
Vol 5 (5) ◽  
Author(s):  
Patricia J Simner ◽  
Katherine E Goodman ◽  
Karen C Carroll ◽  
Anthony D Harris ◽  
Jennifer H Han ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Acute Care ◽  
Care Facility ◽  
Health Care Facility ◽  
Patient Risk ◽  
Acute Care Facility ◽  
Carbapenem Resistant ◽  
Enterobacteriaceae Infections ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Evaluating all inpatient carbapenem-resistant Enterobacteriaceae (CRE) infections over a 1-year period, 47% were caused by carbapenemase-producing (CP) organisms. Compared with non-CP-CRE patients, patients with CP-CRE had an 18-fold greater odds of a recent stay in a foreign health care facility and a 3-fold greater odds of transfer from a post–acute care facility.

scholarly journals Risk Factors and Outcomes for Patients with Bloodstream Infection Due to Acinetobacter baumannii-calcoaceticus Complex

2014 ◽  
Vol 58 (8) ◽  
pp. 4630-4635 ◽  
Author(s):  
Teena Chopra ◽  
Dror Marchaim ◽  
Paul C. Johnson ◽  
Reda A. Awali ◽  
Hardik Doshi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Acinetobacter Baumannii ◽  
Bloodstream Infection ◽  
Medical Center ◽  
Care Facility ◽  
Health Care Facility ◽  
Positive Culture ◽  
Acinetobacter Calcoaceticus ◽  
Content Type

ABSTRACTIdentifying patients at risk for bloodstream infection (BSI) due toAcinetobacter baumannii-Acinetobacter calcoaceticuscomplex (ABC) and providing early appropriate therapy are critical for improving patient outcomes. A retrospective matched case-control study was conducted to investigate the risk factors for BSI due to ABC in patients admitted to the Detroit Medical Center (DMC) between January 2006 and April 2009. The cases were patients with BSI due to ABC; the controls were patients not infected with ABC. Potential risk factors were collected 30 days prior to the ABC-positive culture date for the cases and 30 days prior to admission for the controls. A total of 245 case patients were matched with 245 control patients. Independent risk factors associated with BSI due to ABC included a Charlson's comorbidity score of ≥3 (odds ratio [OR], 2.34;P= 0.001), a direct admission from another health care facility (OR, 4.63;P< 0.0001), a prior hospitalization (OR, 3.11;P< 0.0001), the presence of an indwelling central venous line (OR, 2.75;P= 0.011), the receipt of total parenteral nutrition (OR, 21.2;P< 0.0001), the prior receipt of β-lactams (OR, 3.58;P< 0.0001), the prior receipt of carbapenems (OR, 3.18;P= 0.006), and the prior receipt of chemotherapy (OR, 15.42;P< 0.0001). The median time from the ABC-positive culture date to the initiation of the appropriate antimicrobial therapy was 2 days (interquartile range [IQR], 1 to 3 days). The in-hospital mortality rate was significantly higher among case patients than among control patients (OR, 3.40;P< 0.0001). BSIs due to ABC are more common among critically ill and debilitated institutionalized patients, who are heavily exposed to health care settings and invasive devices.

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