Pneumococcal disease: a retrospective cohort study on associated factors and risk factors for mortality among hospitalised adults in Singapore

Abstract Background: Streptococcus pneumoniae infections can lead to severe morbidity and mortality, especially in patients with invasive pneumococcal disease (IPD). This study assesses factors associated with pneumococcal disease, and risk factors for mortality among hospitalised adults in Singapore.Methods: Retrospective study of patients with pneumococcal disease, based on streptococcal urinary antigen testing and/or sterile site cultures positive for S. pneumoniae , admitted to a tertiary hospital from 2015-2017. IPD and non-IPD cases were compared against a control group of patients, admitted over the same period but with negative results for the abovementioned tests.Results: We identified 496 pneumococcal disease cases, of whom 92 (18.5%) had IPD. The mean age of cases was 69.1±15.4yrs, and 65.5% were male. Compared with controls (N=9,181), IPD patients were younger (mean age 61.5±16.3yrs, vs 72.2±16.1yrs in controls; p<0.001) and with less co-morbidities [median Charlson’s score 1 (IQR 0-4), vs 3 (1-5) in controls; p<0.001]. IPD patients also had the highest proportions with intensive care unit (ICU) admission (20.7%), inpatient mortality (26.1%) and longest median length of stay [9 (8-17) days]. On multivariate analysis, IPD was negatively associated with prior pneumococcal vaccination (adjusted odds ratio=0.20, 95%CI 0.06–0.69; p=0.011). Risk factors for mortality among pneumococcal disease patients were ICU admission, diagnosis of IPD, age ≥85yrs and Charlson’s score >3.Conclusion: Patients with pneumococcal disease (especially IPD) were younger and had less co-morbidities than controls, but had higher risk of severe clinical outcomes and mortality. Pneumococcal vaccination was negatively associated with IPD and should be encouraged among high-risk patients.

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Epidemiology, vaccine effectiveness, and risk factors for mortality for pneumococcal disease among hospitalised adults in Singapore: a retrospective case-cohort study

10.21203/rs.2.13072/v2 ◽

2020 ◽

Author(s):

Tyson Chan ◽

Min Zhi Tay ◽

Win Mar Kyaw ◽

Angela Chow ◽

Hanley J Ho

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Pneumococcal Disease ◽

Multivariable Analysis ◽

Pneumococcal Vaccination ◽

Vaccine Effectiveness ◽

Retrospective Case ◽

Negatively Associated ◽

Factors Associated ◽

Icu Admission

Abstract Background: Streptococcus pneumoniae infections can lead to severe morbidity and mortality, especially in patients with invasive pneumococcal disease (IPD). This study evaluated factors associated with pneumococcal disease, pneumococcal vaccine effectiveness, and risk factors for mortality among hospitalised adults with pneumococcal disease in Singapore. Methods: Retrospective case-cohort study of patients tested for pneumococcal disease with streptococcal urinary antigen testing and at least one sterile site culture, during their admission to a tertiary hospital in Singapore from 2015-2017. Patients were defined as cases of IPD or non-IPD, or as controls, based on laboratory results and clinical diagnoses. Multivariable models were constructed to determine factors associated with IPD/non-IPD, and risk factors for mortality from pneumococcal disease. Vaccine effectiveness against IPD/non-IPD was estimated using a variation of the test-negative design. Results: We identified 496 pneumococcal disease cases, of whom 92 (18.5%) had IPD. The mean age of cases was 69.1±15.4yrs, and 65.5% were male. Compared with controls (N=9,181), IPD patients were younger (mean age 61.5±16.3yrs, vs 72.2±16.1yrs in controls; p<0.001) and with less co-morbidities [median Charlson’s score 1 (IQR 0-4), vs 3 (1-5) in controls; p<0.001]. IPD patients also had the highest proportions with intensive care unit (ICU) admission (20.7%), inpatient mortality (26.1%) and longest median length of stay [9 (IQR 8-17) days]. On multivariable analysis, IPD was negatively associated with prior pneumococcal vaccination (relative risk ratio=0.20, 95%CI 0.06–0.69; p=0.011). Risk factors for mortality among pneumococcal disease patients were ICU admission, diagnosis of IPD, age ≥85yrs and Charlson’s score >3.Conclusion: Patients with pneumococcal disease (especially IPD) were younger and had less co-morbidities than controls, but had higher risk of severe clinical outcomes and mortality. Pneumococcal vaccination was negatively associated with IPD and should be encouraged among high-risk patients.

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Epidemiology, vaccine effectiveness, and risk factors for mortality for pneumococcal disease among hospitalised adults in Singapore: a case-control study

10.21203/rs.2.13072/v4 ◽

2020 ◽

Author(s):

Tyson Chan ◽

Min Zhi Tay ◽

Win Mar Kyaw ◽

Angela Chow ◽

Hanley J Ho

Keyword(s):

Risk Factors ◽

Pneumococcal Disease ◽

Case Control Study ◽

Pneumococcal Vaccination ◽

Case Control ◽

Vaccine Effectiveness ◽

Adjusted Relative Risk ◽

Factors Associated ◽

Icu Admission ◽

Control Study

Abstract Background: Streptococcus pneumoniae infections can lead to severe morbidity and mortality, especially in patients with invasive pneumococcal disease (IPD). This study evaluated factors associated with pneumococcal disease, pneumococcal vaccine effectiveness, and risk factors for all-cause mortality in hospitalised adults with pneumococcal disease in Singapore. Methods: Retrospective case-control study of patients tested for pneumococcal disease with streptococcal urinary antigen testing and at least one sterile site culture, during their admission to a tertiary hospital in Singapore from 2015-2017. Patients were defined as cases of IPD or non-IPD, or as controls, based on laboratory results and clinical diagnoses. Multivariable models were constructed to determine factors associated with IPD/non-IPD, and risk factors for mortality from pneumococcal disease. Vaccine effectiveness against IPD/non-IPD was estimated using a variation of the test-negative design. Results: We identified 496 pneumococcal disease cases, of whom 92 (18.5%) had IPD. The mean age of cases was 69.1±15.4yrs, and 65.5% were male. Compared with controls (N=9,181), IPD patients were younger (mean age 61.5±16.3yrs, vs 72.2±16.1yrs in controls; p<0.001) and with less co-morbidities [median Charlson’s score 1 (IQR 0-4), vs 3 (1-5) in controls; p<0.001]. IPD patients also had the highest proportions with intensive care unit (ICU) admission (20.7%), inpatient mortality (26.1%) and longest median length of stay [9 (IQR 8-17) days]. On multivariable analysis, IPD was negatively associated with prior pneumococcal vaccination (adjusted relative risk ratio=0.20, 95%CI 0.06–0.69; p=0.011). Risk factors for mortality among pneumococcal disease patients were ICU admission, diagnosis of IPD, age ≥85yrs and Charlson’s score >3.Conclusion: Patients with pneumococcal disease (especially IPD) were younger and had less co-morbidities than controls, but had higher risk of severe clinical outcomes and mortality. Pneumococcal vaccination effectiveness against IPD was estimated to be about 80%, and should be encouraged among high-risk patients.

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Epidemiology, vaccine effectiveness, and risk factors for mortality for pneumococcal disease among hospitalised adults in Singapore: a case-control study

10.21203/rs.2.13072/v3 ◽

2020 ◽

Author(s):

Tyson Chan ◽

Min Zhi Tay ◽

Win Mar Kyaw ◽

Angela Chow ◽

Hanley J Ho

Keyword(s):

Risk Factors ◽

Pneumococcal Disease ◽

Case Control Study ◽

Pneumococcal Vaccination ◽

Case Control ◽

Vaccine Effectiveness ◽

Adjusted Relative Risk ◽

Factors Associated ◽

Icu Admission ◽

Control Study

Abstract Background: Streptococcus pneumoniae infections can lead to severe morbidity and mortality, especially in patients with invasive pneumococcal disease (IPD). This study evaluated factors associated with pneumococcal disease, pneumococcal vaccine effectiveness, and risk factors for all-cause mortality in hospitalised adults with pneumococcal disease in Singapore. Methods: Retrospective case-control study of patients tested for pneumococcal disease with streptococcal urinary antigen testing and at least one sterile site culture, during their admission to a tertiary hospital in Singapore from 2015-2017. Patients were defined as cases of IPD or non-IPD, or as controls, based on laboratory results and clinical diagnoses. Multivariable models were constructed to determine factors associated with IPD/non-IPD, and risk factors for mortality from pneumococcal disease. Vaccine effectiveness against IPD/non-IPD was estimated using a variation of the test-negative design. Results: We identified 496 pneumococcal disease cases, of whom 92 (18.5%) had IPD. The mean age of cases was 69.1±15.4yrs, and 65.5% were male. Compared with controls (N=9,181), IPD patients were younger (mean age 61.5±16.3yrs, vs 72.2±16.1yrs in controls; p<0.001) and with less co-morbidities [median Charlson’s score 1 (IQR 0-4), vs 3 (1-5) in controls; p<0.001]. IPD patients also had the highest proportions with intensive care unit (ICU) admission (20.7%), inpatient mortality (26.1%) and longest median length of stay [9 (IQR 8-17) days]. On multivariable analysis, IPD was negatively associated with prior pneumococcal vaccination (adjusted relative risk ratio=0.20, 95%CI 0.06–0.69; p=0.011). Risk factors for mortality among pneumococcal disease patients were ICU admission, diagnosis of IPD, age ≥85yrs and Charlson’s score >3.Conclusion: Patients with pneumococcal disease (especially IPD) were younger and had less co-morbidities than controls, but had higher risk of severe clinical outcomes and mortality. Pneumococcal vaccination effectivenessagainst IPD was estimated to be about 80%, and should be encouraged among high-risk patients.

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Epidemiology, vaccine effectiveness, and risk factors for mortality for pneumococcal disease among hospitalised adults in Singapore: a case-control study

10.21203/rs.2.13072/v5 ◽

2020 ◽

Author(s):

Tyson Chan ◽

Min Zhi Tay ◽

Win Mar Kyaw ◽

Angela Chow ◽

Hanley J Ho

Keyword(s):

Risk Factors ◽

Pneumococcal Disease ◽

Case Control Study ◽

Pneumococcal Vaccination ◽

Case Control ◽

Vaccine Effectiveness ◽

Adjusted Relative Risk ◽

Factors Associated ◽

Icu Admission ◽

Control Study

Abstract Background: Streptococcus pneumoniae infections can lead to severe morbidity and mortality, especially in patients with invasive pneumococcal disease (IPD). This study evaluated factors associated with pneumococcal disease, pneumococcal vaccine effectiveness, and risk factors for all-cause mortality in hospitalised adults with pneumococcal disease in Singapore. Methods: Retrospective case-control study of patients tested for pneumococcal disease with streptococcal urinary antigen testing and at least one sterile site culture, during their admission to a tertiary hospital in Singapore from 2015-2017. Patients were defined as cases of IPD or non-IPD, or as controls, based on laboratory results and clinical diagnoses. Multivariable models were constructed to determine factors associated with IPD/non-IPD, and risk factors for mortality from pneumococcal disease. Vaccine effectiveness against IPD/non-IPD was estimated using a variation of the test-negative design. Results: We identified 496 pneumococcal disease cases, of whom 92 (18.5%) had IPD. The mean age of cases was 69.1±15.4yrs, and 65.5% were male. Compared with controls (N=9,181), IPD patients were younger (mean age 61.5±16.3yrs, vs 72.2±16.1yrs in controls; p<0.001) and with less co-morbidities [median Charlson’s score 1 (IQR 0-4), vs 3 (1-5) in controls; p<0.001]. IPD patients also had the highest proportions with intensive care unit (ICU) admission (20.7%), inpatient mortality (26.1%) and longest median length of stay [9 (IQR 8-17) days]. On multivariable analysis, IPD was negatively associated with prior pneumococcal vaccination (adjusted relative risk ratio=0.20, 95%CI 0.06–0.69; p=0.011). Risk factors for mortality among pneumococcal disease patients were ICU admission, diagnosis of IPD, age ≥85yrs and Charlson’s score >3. Conclusion: Patients with pneumococcal disease (especially IPD) were younger and had less co-morbidities than controls, but had higher risk of severe clinical outcomes and mortality. Pneumococcal vaccination effectivenessagainst IPD was estimated to be about 80%, and should be encouraged among high-risk patients.

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684. Risk Stacking for Pneumococcal Disease in Costa Rica

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.691 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S247-S247

Author(s):

Jorge Chaverri-Murillo ◽

Manuel Ramírez-Cardoce ◽

José Castro-Cordero

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Costa Rica ◽

High Risk ◽

Pneumococcal Disease ◽

Heart Diseases ◽

High Risk Factor ◽

Tertiary Hospitals ◽

Risk Patients ◽

Culture Positive

Abstract Background The value of nontraditional high-risk factor stacking is not known in the Costa Rican population. We aim to describe risk factor stacking for pneumococcal disease (PD) in patients seeking care at Social Security Hospitals in Costa Rica Methods Descriptive study of adult patients with microbiological culture-positive Streptococcus pneumoniae disease seeking care at two tertiary hospitals in Costa Rica between years 2014 and 2016. Information on underlying comorbidities (nontraditional) and other risk factors for PD was analyzed and stalked for each age group (G1: <50, G2: 50–64, and G3: ≥65 y/o). Results We included 181 culture-positive patients. We found that patients in G1 predominantly stacked ≥2 risk factors (63%), the proportion of patients with ≥2 risk factor was similar to high-risk patients in G2 (33% vs. 38%). In G3, 18% didn’t stacked any other risk factor and 46% was on high-risk. Most frequent risk factors in G1/G2 were smoking and alcoholism, and in G3 chronic pulmonary and heart diseases. Conclusion We conclude that risk factor stacking is more relevant than high-risk conditions and PD also occurs in persons <50 y/o. We recommend that risk factor stacking should be considered in prevention strategies for PD. Disclosures All authors: No reported disclosures.

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A Virtual Clinic Improves Pneumococcal Vaccination for Asplenic Veterans at High Risk for Pneumococcal Disease

Open Forum Infectious Diseases ◽

10.1093/ofid/ofv165 ◽

2015 ◽

Vol 2 (4) ◽

Cited By ~ 3

Author(s):

Robin L. Jump ◽

Richard Banks ◽

Brigid Wilson ◽

Michelle M. Montpetite ◽

Rebecca Carter ◽

...

Keyword(s):

High Risk ◽

Medical Record ◽

Electronic Medical Record ◽

Pneumococcal Disease ◽

Pneumococcal Vaccination ◽

Vaccination Status ◽

High Risk Patients ◽

Risk Patients ◽

Virtual Clinic

Abstract We developed a “virtual clinic” to improve pneumococcal vaccination among asplenic adults. Using an electronic medical record, we identified patients, assessed their vaccination status, entered orders, and notified patients and providers. Within 180 days, 38 of 76 patients (50%) received a pneumococcal vaccination. A virtual clinic may optimize vaccinations among high-risk patients.

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Risk Factors for Multidrug-Resistant Invasive Pneumococcal Disease in South Africa, a Setting with High HIV Prevalence, in the Prevaccine Era from 2003 to 2008

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.06463-11 ◽

2012 ◽

Vol 56 (10) ◽

pp. 5088-5095 ◽

Cited By ~ 23

Author(s):

Penny Crowther-Gibson ◽

Cheryl Cohen ◽

Keith P. Klugman ◽

Linda de Gouveia ◽

Anne von Gottberg

Keyword(s):

Risk Factors ◽

South Africa ◽

Multidrug Resistance ◽

Invasive Pneumococcal Disease ◽

Pneumococcal Disease ◽

Hospital Admissions ◽

Significant Risk ◽

Pneumococcal Vaccination ◽

Multidrug Resistant ◽

Content Type

ABSTRACTThe emergence of multidrug-resistant (MDR)Streptococcus pneumoniaecomplicates disease management. We aimed to determine risk factors associated with MDR invasive pneumococcal disease (IPD) in South Africa and evaluate the potential for vaccination to reduce disease burden. IPD data collected by laboratory-based surveillance from 2003 through 2008 were analyzed. Multidrug resistance was defined as nonsusceptibility to any three or more different antibiotic classes. Risk factors for multidrug resistance were evaluated using multivariable logistic regression. Of 20,100 cases of IPD identified, 3,708 (18%) had MDR isolates, with the proportion increasing from 16% (461/2,891) to 20% (648/3,326) (P< 0.001) over the study period. Serotypes included in the 13-valent pneumococcal conjugate vaccine (PCV13) accounted for 94% of MDR strains. Significant risk factors for MDR IPD included PCV13 (1,486/6,407; odds ratio [OR] of 6.3; 95% confidence interval [CI] of 5.0 to 7.9) and pediatric (3,382/9,980; OR of 12.8; 95% CI of 10.6 to 15.4) serotypes, age of <5 (802/3,110; OR of 2.0; 95% CI of 1.8 to 2.3) or ≥65 (39/239; OR of 1.5; 95% CI of 1.0 to 2.2) years versus age of 15 to 64 years, HIV infection (975/4,636; OR of 1.5; 95% CI of 1.2 to 1.8), previous antibiotic use (242/803; OR of 1.7; 95% CI of 1.4 to 2.1), previous hospital admissions (579/2,450; OR of 1.2; 95% CI of 1.03 to 1.4), urban location (883/4,375; OR of 2.0; 95% CI of 1.1 to 3.5), and tuberculosis treatment (246/1,021; OR of 1.2; 95% CI of 1.03 to 1.5). MDR IPD prevalence increased over the study period. The effect of many of the MDR risk factors could be reduced by more judicious use of antibiotics. Because PCV13 serotypes account for most MDR infections, pneumococcal vaccination may reduce the prevalence of multidrug resistance.

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Incidence, risk factors and management of post cesarean section surgical site infection (SSI) in a tertiary hospital in Egypt: a five year retrospective study

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04054-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Khaled Gomaa ◽

Ahmed R. Abdelraheim ◽

Saad El Gelany ◽

Eissa M. Khalifa ◽

Ayman M. Yousef ◽

...

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Mortality Rate ◽

Cesarean Section ◽

Surgical Site Infection ◽

Significant Risk ◽

Tertiary Hospital ◽

Control Group ◽

Site Infection ◽

Incidence Risk

Abstract Background Surgical site infection (SSI) is one of the commonest complications following cesarean section (CS) with a reported incidence of 3–20%. SSI causes massive burdens on both the mother and the health care system. Moreover, it is associated with high maternal morbidity and mortality rate of up to 3%. This study aims to determine the incidence, risk factors and management of SSI following CS in a tertiary hospital. Methods This was an observational case control retrospective study which was conducted at Minia maternity university hospital, Egypt during the period from January 2013 to December 2017 (Five years). A total of 15,502 CSs were performed during the studied period, of these, 828 cases developed SSI following CS (SSI group). The control group included 1500 women underwent cesarean section without developing SSI. The medical records of both groups were reviewed regarding the sociodemographic and the clinical characteristics. Results The incidence of SSI post-cesarean section was 5.34%. Significant risk factors for SSI were; chorioamnionitis (adjusted odds ratio (AOR) 4.51; 95% CI =3.12–6.18), premature rupture of membranes (PROM) (AOR 3.99; 95% CI =3.11–4.74), blood loss of > 1000 ml (AOR 2.21; 95% CI =1.62–3.09), emergency CS (AOR 2.16; 95% CI =1.61–2.51), duration of CS of > 1 h (AOR 2.12; 95% CI =1.67–2.79), no antenatal care (ANC) visits (AOR 2.05; 95% CI =1.66–2.37), duration of labor of ≥24 h (AOR 1.45; 95% CI =1.06–2.01), diabetes mellitus (DM) (AOR 1.37; 95% CI =1.02–2.1 3), obesity (AOR 1.34; 95% CI =0.95–1.84), high parity (AOR 1.27; 95% CI = 1.03–1.88), hypertension (AOR 1.19; 95% CI = 0.92–2.11) and gestational age of < 37 wks (AOR 1.12; 95% CI = 0.94–1.66). The mortality rate due to SSI was 1.33%. Conclusions The obtained incidence of SSI post CS in our study is relatively lower than other previous studies from developing countries. The development of SSI is associated with many factors rather than one factor. Management of SSI is maninly medical but surgical approach may be needed in some cases. Registration Local ethical committee (Registration number: MOBGYN0040).

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530. Sequential Screening of High-Risk Patients for Carbapenemase-Producing Enterobacteriaceae Colonization

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.599 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S255-S255

Author(s):

Elizabeth Brodkin ◽

Katy Short ◽

Dale Purych

Keyword(s):

Risk Factors ◽

High Risk ◽

Control Measures ◽

Nosocomial Transmission ◽

High Risk Patients ◽

Recent Exposure ◽

Sequential Screening ◽

Negative Results ◽

Infection Control Measures ◽

Risk Patients

Abstract Background Early identification of patients colonized with carbapenemase-producing Enterobacteriaceae (CPE) facilitates the implementation of appropriate infection control measures and reduces nosocomial transmission. Sequential screening for CPE colonization of close contacts of known cases to confirm initial negative results is recommended. Fraser Health (FH) expanded sequential screening to patients with recent exposure to other risk factors following the identification of CPE in patients who initially screened negative. Methods FH screens patients for CPE who report healthcare outside of Canada or travel to endemic countries within the previous 12 months. Patients remain on contact precautions and are re-screened 7 and 21 days after the last known exposure date. We reviewed CPE cases with foreign healthcare or travel to endemic countries who screened negative on admission but subsequently screened positive within 30 days. Patients without confirmation of colonization through a rectal screen or possible exposure to a current nosocomial source were excluded. Whole-genome sequencing results were examined to confirm foreign healthcare or travel as the likely source of acquisition. Medical records were reviewed to obtain patient history and clinical details. Results Between November 2015 and January 2019, 21 patients had a positive CPE screen within 30 days of a negative screen, with no known CPE exposures during that time. The median time between the last date of known exposure and positive CPE screen was 20 days (range: 7–77 days). Twelve (57%) cases were hospitalized outside of Canada, 8 (38%) reported other foreign healthcare encounters, and 1 (5%) had no reported healthcare outside of Canada but had traveled to an endemic country. Sixteen (71%) cases received antibiotics prior to the positive CPE screen. Conclusion Patients with unrecognized CPE colonization are a source for nosocomial transmission. Patients screening negative for CPE with recent exposure to risk factors other than contact with a known case may screen positive at a later date. This may be due to higher colonization levels or antibiotic selection pressures. Consideration should be given to sequential CPE screening of high-risk patients based on the last day of exposure. Disclosures All authors: No reported disclosures.

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Risk Factors Associated with Vancomycin-ResistantEnterococcusin Intensive Care Unit Settings in Saudi Arabia

Interdisciplinary Perspectives on Infectious Diseases ◽

10.1155/2013/369674 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 7

Author(s):

Mahmoud Shorman ◽

Jaffar A. Al-Tawfiq

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Saudi Arabia ◽

Intensive Care ◽

Antimicrobial Agents ◽

Multiorgan Failure ◽

Tertiary Hospital ◽

Oral Contrast ◽

Factors Associated ◽

Icu Admission

Background. Vancomycin-resistant enterococci (VRE) are significant nosocomial pathogens worldwide. There is one report about the epidemiology of VRE in Saudi Arabia.Objective. To determine the risk factors associated with VRE infection or colonization in intensive care unit (ICU) settings.Design. This is a descriptive, epidemiologic hospital-based case-control study of patients with VRE from February 2006 to March 2010 in ICU in a tertiary hospital in Saudi Arabia.Methods. Data were collected from hospital records of patients with VRE. The main outcome measure was the adjusted odds ratio estimates of potential risk factors for VRE.Results. Factors associated with VRE included ICU admission for multiorgan failure, chronic renal failure, prior use of antimicrobial agents in the past three months and before ICU admission, gastrointestinal oral contrast procedure, and hemodialysis. Being located in a high risk room (roommate of patients colonized or infected with VRE) was found to be protective.Conclusions. Factors associated with VRE acquisition are often complex and may be confounded by local variables.

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