scholarly journals Does Carbapenem Resistant Enterobacteriaceae Infection Drive Venous Thromboembolism in Patients Admitted to Intensive Care Units Receiving Prophylactic Anticoagulants?

2021 ◽  
Author(s):  
Fahad Aleidan ◽  
Sara Albilal ◽  
Maha Alammari ◽  
Khalid Al Sulaiman ◽  
Mohammed Alassiri ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Venous Thromboembolism ◽  
Conditional Logistic Regression ◽  
Icu Patients ◽  
Carbapenem Resistant ◽  
Failure Assessment ◽  
Matched Case ◽  
Independent Risk Factors ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract BackgroundSystemic infections are one of several risk factors leading to the development of inflammation and venous thromboembolism (VTE) formation.Aim of the studyTo assess the risk factors associated with the development of VTE during the stay of critically ill patients in the intensive care unit (ICU).Materials and methodsThis is a matched case-control study of patients with VTE admitted to the ICU, at a single centre, from January 1 2018 to December 31 2019. We included all adult patients who stayed more than two days before the development of VTE. Conditional logistic regression was used to estimate the odds ratio (OR) for the risk factors for VTE.ResultsUnivariate and multivariate analyses uncovered three of six factors to have significant influence in the development of VTE in ICU patients: Carbapenem-resistant Enterobactereaceae (CRE) infections (OR 2.95, 95% confidence interval (CI) 1.21–7.33, p = .010), length of ICU stay (OR 1.02, 95% CI 1.01–1.04, p = .011) and the sequential organ failure assessment (SOFA) score (OR 1.10, 95% CI 1.01–1.20, p = .031); all were found to be independent risk factors in the development of VTE.ConclusionOur findings suggest that in patients admitted to the ICU, CRE infection is a strong trigger to the development of VTE, and draw the attention of the treating clinicians to prioritise these infections in the management protocols to control infection-driven VTE in ICU patients.

scholarly journals Surveillance of healthcare-associated infections in a Tunisian university hospital

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
H Hannachi ◽  
A Ben Cheikh ◽  
S Bhiri ◽  
H Ghali ◽  
S Khefacha ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
University Hospital ◽  
Healthcare Associated Infections ◽  
Drug Resistant ◽  
Healthcare Associated Infection ◽  
Carbapenem Resistant ◽  
Independent Risk Factors ◽  
Healthcare Associated

Abstract Introduction Healthcare -associated infections has become a worldwide public health problem. The aim of this study was to estimate the incidence of healthcare- associated infections in a university hospital of Tunisia. Methods This was a cohort study conducted in six intensive care units in a university hospital of Tunisia during three months (from august to October 2018). Data was provided from patients’ files. Data entry and analysis was done using SPSS version 22. Multivariate analysis was used in order to identify independent risk factors for healthcare associated infection. Results A total of 202 patients were enrolled in this study. The incidence rate of healthcare-associated infections was 53,96%(109/202). The ratio infection/infected was estimated to 1.65(109/66). The incidence of multi-drug resistant pathogens was 21,28% (43/202). The most common resistant pathogens included pseudomonas aeruginosa resistant to cefdazidime in 13,76%(15/109) followed by those resistant to extended spectrum cephalosporin 11.92% (13/109), followed by carbapenem-resistant acinetobcater baumanii 6,42%(7/109) then by carbapenem resistant pathogens and enterococcus resistant to vancomycin 2.75%(3/109) and finally staphylococcus aureus resistant to methicillin 2.1%(2/1.83). The multivariate analysis showed that long duration of central line catheterisation (RR = 7.44; 95%CI[2.79-19.82]), tracheotomy(RR = 8.61;95%CI[2.09-35,39]) and length of stay (RR = 1.08; 95%CI[1.04-1.13]) were found as independent risk factors for healthcare -associated infection. Conclusions The emergence of mutli-drug resistant pathogens needs to be deeply studied and effective measures have to be taken in order to detect and prevent transmission of resistant strains and/or their resistance determinants, especially those with phenotypes having the fewest viable treatment options. Key messages The incidence of healthcare associated infection in the intensive care unit was high. Effective measures have to be taken in the intensive care unit to detect and prevent transmission of resistant pathogens.

scholarly journals 495. Risk Factors of Carbapenem-Resistant Enterobacteriaceae (CRE) Infections Among Intensive Care Unit (ICU) Patients in a Tertiary Hospital in the Philippines

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S241-S242
Author(s):  
Roderick Oreal Torio ◽  
Danielle Nicole T Paras ◽  
Cybele Lara R Abad
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Length Of Hospital Stay ◽  
The Philippines ◽  
Common Site ◽  
Carbapenem Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background The threat of Carbapenem-Resistant Enterobacteriaceae (CRE) is increasing worldwide, and the epidemiology, risk factors, and outcomes of CRE in the Philippines is unknown. Methods We performed a retrospective case–control study of 128 CRE cases and Carbapenem-Susceptible Enterobacteriaceae (CSE) controls matched 1:1 based on site of infection and date of admission among all adult patients in the Intensive Care Unit (ICU) between January 2014 and May 2018 at The Medical City. Predictors of CRE infection among matched cases and controls were determined through multiple conditional logistic regression analysis. In-hospital mortality was analyzed using z-test of two proportions and length of stay among patients with CRE and CSE were compared. Results The mean age in both groups was similar at 65.8 (range 23–92) and 64.3 (range 23–98) years, respectively. There were more males among cases than controls [(76/128, 59%) vs. 62/128 (48%)]. Those with CRE were more likely to have a co-morbid illness and an invasive device. Pneumonia was the most common site of CRE infection (40%) followed by the urinary tract (27%). Enterobacter cloacae (54.68%) was the most common organism, followed by Klebsiella pneumoniae (30.46%). On univariate analysis, the use of piperacillin–tazobactam, third or fourth-generation cephalosporins and carbapenems, mechanical ventilation, and acute kidney injury (AKI) increased the risk of developing CRE infections by an OR of 7.5 (CI 1.88–29.95, P = 0.004), 9.32 (CI 1.48–58.59, P = 0.017), and 10.76 (CI 1.69–68.53, P = 0.012), respectively. Those with CRE had a higher in-hospital mortality than the CSE group [(49/79, 38.3%) vs. (33/95, 25.8%); P = 0.032]. Length of hospital stay among CRE cases was also longer with a mean of 43.9 vs. 28 days compared with controls. Conclusion In our cohort, older patients w/ comorbidities developed CRE with pneumonia being the most common site of infection. Prior use of broad-spectrum antimicrobials, mechanical ventilation and AKI appeared to increase the risk of CRE infection in the ICU. CRE infection also increased patient mortality and length of hospital stay. Interventions that target these risk factors should be undertaken to help prevent CRE infection. Disclosures All authors: No reported disclosures.

Impact of Early Reinitiation of Neuropsychiatric Medications on Agitation and Delirium in the Intensive Care Unit: A Retrospective Study

2020 ◽  
Vol 55 (1) ◽  
pp. 15-24
Author(s):  
Michaelia D. Cucci ◽  
Brittany S. Cunningham ◽  
Jaimini S. Patel ◽  
Alan T. Shimer ◽  
Dania I. Mofleh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Primary Outcome ◽  
Tertiary Care ◽  
Group Versus ◽  
Care Hospital ◽  
Icu Patients ◽  
Independent Risk Factors ◽  
The Impact

Background: Approximately 17% of intensive care unit (ICU) patients are prescribed at least 1 home neuropsychiatric medication (NPM). When abruptly discontinued, withdrawal symptoms may occur manifesting as agitation or delirium in the ICU setting. Objective: To evaluate the impact of early reinitiation of NPMs. Methods: This was a retrospective, observational cohort of adult ICU patients in a tertiary care hospital. Patients were included if admitted to the ICU and prescribed a NPM prior to arrival. Study groups were based on the timing of reinitiation of at least 50% of NPMs: ≤72 hours (early group) versus >72 hours (late group). Results: The primary outcome was the proportion of patients with at least 1 agitation or delirium episode in the first 72 hours. Agitation and delirium were defined as at least 1 RASS assessment between +2 to +4 and a positive CAM-ICU assessment, respectively. A total of 300 patients were included, with 187 (62%) and 113 (38%) in the early and late groups, respectively. There was no difference in agitation or delirium (late 54 [48%] vs early 62 [33%]; adjusted odds ratio [aOR] = 1.5; 95% CI = 0.8-2.8; P = 0.193). Independent risk factors found to be associated with the primary outcome were restraints (aOR = 12.9; 95% CI = 6.9-24.0; P < 0.001) and benzodiazepines (BZDs; aOR = 2.0; 95% CI = 1.0-3.7; P = 0.038). Conclusions: After adjustment for baseline differences, there was no difference in agitation or delirium. Independent risk factors were restraint use and newly initiated BZDs.

scholarly journals 1250. Prevalence and Risk Factors for Acquiring Carbapenem-Resistant Enterobacteriaceae in an Intensive Care Unit at a Tertiary Hospital

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S380-S380
Author(s):  
Jin Suk Kang ◽  
Soon Ok Lee ◽  
Jeong Eun Lee ◽  
So Ra Kim ◽  
Han Wool Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Common Species ◽  
Tertiary Hospital ◽  
Multidrug Resistant ◽  
Invasive Infection ◽  
Acinetobacter Species ◽  
Carbapenem Resistant ◽  
Invasive Infections ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Active surveillance testing of carbapenem-resistant Enterobacteriaceae (AST-CRE) is recommended in high-risk settings, such as intensive care units (ICUs), to prevent CRE outbreaks or invasive infections. This study aimed to investigate the effects of AST-CRE by analyzing the prevalence and risk factors for acquiring CRE during the ICU care. Methods We conducted AST-CRE on rectal swabs of patients admitted to the ICU in the emergency room at a tertiary hospital in South Korea for 12.5 months. AST-CRE was performed upon admission and weekly thereafter. To assess the risk factors of acquiring AST-CRE during the admission period in adult patients, those colonized with CRE upon admission and aged &lt;18 years were excluded. AST-CRE was performed using Centers for Disease Control and Prevention methods. A polymerase chain reaction assay was performed to detect five carbapenemase genes (NDM, KPC, VIM, IMP, and OXA). Results A total of 810 patients were admitted during the study period. The acquisition rate and carbapenemase-producing CRE were 2.6% (21/810) and 42.9% (9/21), respectively. No invasive infection due to CRE was found. The most common species were Klebsiella pneumoniae (71.4%, 15/21), and eight KPC and one NDM genes were detected. In CRE-positive patients, in-hospital mortality and length of hospitalization were higher (P = 0.003) and longer (P &lt; 0.001), respectively. Multivariate analyses showed that male gender (adjusted odds ratio [aOR] 8.0; 95% confidence interval [CI] 1.7–36.8), previous hospitalization in the last year (aOR 5.1; 95% CI 1.6–16.4), co-colonization with multidrug-resistant Acinetobacter species (aOR 18.3; 95% CI, 4.2–79.2) and extended-spectrum β-lactamase-producing bacteria (aOR 3.4; 95% CI, 1.1–10.9), and length of ICU admission until CRE detection for ≥10 days (aOR 6.5; 95% CI 2.2–19.2) were independently associated with CRE acquisition. Conclusion To prevent CRE outbreak or invasive infections, patients admitted in the ICU should be screened using AST-CRE. Disclosures All authors: No reported disclosures.

scholarly journals Clinical Characteristics and Risk Factors for COVID-19-associated Candidemia

2021 ◽  
Author(s):  
Ali S Omrani ◽  
Junais Koleri ◽  
Fatma Ben Abid ◽  
Joanne Daghfel ◽  
Thasneem Odaippurath ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Regression Analysis ◽  
Intensive Care ◽  
Older Patients ◽  
Clinical Characteristics ◽  
Conditional Logistic Regression ◽  
Conditional Logistic Regression Analysis ◽  
Failure Assessment ◽  
Candida Bloodstream Infection

Abstract Patients with COVID-19-associated candidemia (CAC) in an intensive care unit (ICU) were matched 1:2 with those without candidemia, based on ICU admission date and length of stay in ICU being at least equal to that before candidemia in the corresponding case. The incidence rate of CAC was 2.34 per 1,000 ICU days. Eighty cases could be matched to appropriate controls. In the multivariate conditional logistic regression analysis, age (P 0.001), and sequential organ failure assessment score (P 0.046) were the only risk factors independently associated with CAC. Tocilizumab and corticosteroids therapy were not independently associated with candidemia. Lay Summary In COVID-19 patients who need medical care in an intensive care unit, the risk of developing bloodstream Candida infection is higher in older patients and in those who have a more severe critical illness. Treatment with steroids or tocilizumab does not seem to affect the risk of candida bloodstream infection in these patients.

The Colonization of Carbapenem-Resistant Klebsiella pneumoniae: Epidemiology, Resistance Mechanisms, and Risk Factors in Patients Admitted to Intensive Care Units in China

2020 ◽  
Vol 221 (Supplement_2) ◽  
pp. S206-S214 ◽  
Author(s):  
Xiaohua Qin ◽  
Shi Wu ◽  
Min Hao ◽  
Jing Zhu ◽  
Baixing Ding ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Consensus Sequence ◽  
Resistance Mechanisms ◽  
Transmitted Infection ◽  
Icu Patients ◽  
Icu Stay ◽  
Carbapenem Resistant ◽  
Increased Risk

Abstract Background Carbapenem-resistant Klebsiella pneumoniae (CRKP) has become a threat to public health, most notably as a superbug causing nosocomial infections. Patients in the intensive care unit (ICU) are at increased risk of hospital-acquired K pneumoniae infection, especially CRKP. This study was conducted to investigate the frequency of gastrointestinal and nasopharyngeal K pneumoniae colonization and its contribution to infections in ICU patients. Methods A 3-month prospective cohort study was performed in which 243 ICU patients were screened for intestinal and nasopharyngeal carriage of K pneumoniae at admission and once per week thereafter. The colonization and clinical infection isolates were analyzed by antimicrobial susceptibility testing to identify CRKP and were characterized by multilocus sequence typing (MLST) and whole-genome sequencing combined with epidemiological data to investigate the resistance mechanisms and assess the possible transmitted infection. Results Twenty-eight percent (68 of 243) of patients tested positive for carriage of K pneumoniae immediately upon admission to ICU, 54% (37 of 68) of which were nonduplicate CRKP isolates. Patients with carbapenem-susceptible K pneumoniae (CSKP) colonization at admission were more likely to acquire CRKP colonization during the ICU stay compared with patients without K pneumoniae colonization at admission. The incidence of subsequent CRKP infection in the baseline CSKP (32.3%, 10 of 31) and CRKP (45.9%, 17 of 37) carrier group was significantly higher than that of the baseline non-KP carrier group (8.6%, 15 of 175). The risk factors associated with acquired CRKP colonization during the ICU stay among negative CRKP colonization at admission included previous exposure to carbapenem, tigecycline or β-lactam/β-lactamases inhibitor, and invasive processes or surgical operations. Sixty-four percent (27 of 42) of patients with K pneumoniae infection were colonized by clonally related K pneumoniae strains according to enterobacterial repetitive intergenic consensus sequence-polymerase chain reaction analysis. ST11 (72%, 53 of 74) was the most predominant MLST type of clonally related CRKP isolate colonizing these patients, followed by ST15 (26%, 19 of 74). Conclusions The colonization of K pneumoniae may increase the incidence of corresponding K pneumoniae infection in critically ill patients in the ICU. High prevalence of ST11 CRKP (due to blaKPC-2) carriage and infection in ICU was observed.

scholarly journals The Risk Factors for Pulmonary Tuberculosis Incidence in Ghana: A Small Matched Case-control Study

2020 ◽  
pp. 14-23
Author(s):  
Michael Boah ◽  
Daniel Adjei Amporfro ◽  
Timothy Adampah ◽  
Stephen Bordotsiah ◽  
Baiming Jin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Conditional Logistic Regression ◽  
Case Control ◽  
Northern Ghana ◽  
Monthly Income ◽  
Matched Case ◽  
Independent Risk Factors ◽  
Matched Case Control Study ◽  
Control Study

Aims: Knowing the risk factors for tuberculosis (TB) opens up avenues for identifying target groups for intensified case finding. We aimed to identify the risk factors for pulmonary TB (PTB) incidence in a rural district in northern Ghana. Study Design: A matched case-control study. Place and Duration of Study: The Kassena Nankana West District of the Upper East Region of Ghana, between February 2019 and March 2019. Methodology: This study was conducted in 4 public health facilities. Cases were newly confirmed PTB patients aged 15 years or over, controls were age and sex matched outpatients. A pre-tested questionnaire collected information on a range of possible risk factors from participants. Conditional logistic regression identified independent risk factors for PTB incidence in a multivariable model at 95% confidence level. Results: The analysis included 174 cases and controls. Multivariable analysis showed that the risk of PTB was increased with low household monthly income (AOR=3.45; 95% CI: 1.08-10.97; P=.03), smoking (AOR=2.69; 95% CI: 1.13-6.43; P=.02) as well as household exposure to a known TB case (AOR=2.57; 95% CI: 1.08-6.10; P=.03). Conclusion: Low household monthly income, smoking, and household exposure to a known TB case were independent risk factors for PTB incidence. These factors can be used to actively screen for PTB in the population.

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