Risk Factors and Clinical Analysis for PICC Related Fungal Colonization in Premature Infants

2021 ◽  
Author(s):  
Lingping Zhang ◽  
Liu Yang ◽  
Wenbin Dong ◽  
Xingling Liu ◽  
Xiaoping Lei ◽  
...  
Keyword(s):  
Risk Factors ◽  
Premature Infants ◽  
Operating Characteristic ◽  
Tertiary Hospital ◽  
Clinical Analysis ◽  
Fungal Colonization ◽  
Ultrasound Guided ◽  
Independent Risk Factors ◽  
Positive Results ◽  
Infusion Duration

Abstract Objective: The present study aimed to analyze the risk factors for positive peripherally inserted central catheter (PICC) related fungal colonization in preterm infants. Methods: A retrospective study was conducted in a tertiary hospital in southwest China between January 1, 2018 and December 31, 2020. The enrolled infants who underwent ultrasound-guided PICC insertion during hospitalization were born at < 32 weeks gestation or birth weight < 1500 grams. The demographics, the PICC related characteristics, the use of antibiotic, glucocorticoid and parenteral nutrition (PN) were collected from the medical record. Univariate and multivariate analyses were performed to investigate risk factors for PICC-related fungal colonization. Receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value by calculating the Yoden index. Results: A total of 124 premature infants underwent ultrasound-guided PICC insertion. Among them, 19 patients had positive results of fungi at PICC tips.PN infusion duration (OR 1.37, 95%CI 1.05-1.79) and postnatal glucocorticoid exposure(OR 9.19, 95%CI 1.04-81.65) were independent risk factors for fungal colonization in PICC. The optimal cut-off value was 15days,28days, respectively. Conclusion: PICC tips fungal colonization is affected by postnatal glucocorticoid exposure and PN infusion duration. Appropriate clinical management should be adopted to avoid fungal colonization and fungemia.

scholarly journals Risk factors and clinical analysis of peripherally inserted central catheter-related fungal colonization in premature infants

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Lingping Zhang ◽  
Liu Yang ◽  
Wenbin Dong ◽  
Xingling Liu ◽  
Xiaoping Lei ◽  
...  
Keyword(s):  
Risk Factors ◽  
Parenteral Nutrition ◽  
Premature Infants ◽  
Roc Curves ◽  
Antibiotic Use ◽  
Clinical Analysis ◽  
Fungal Colonization ◽  
Peripherally Inserted Central Catheter ◽  
Central Catheter ◽  
Treatment Information

AbstractWe aimed to analyze the risk factors of positive peripherally inserted central catheter (PICC)-related fungal colonization in preterm infants. This retrospective study collected data from 2018 to 2020. The enrolled infants who underwent PICC insertion were born at < 32 weeks’ gestation or birth weight < 1500 g. The demographics, PICC-related characteristics, and treatment information were collected. Univariate and multivariate analyses were performed to investigate risk factors for PICC-related fungal colonization. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off values for the duration of antibiotics and parenteral nutrition. In total, 124 premature infants underwent PICC insertion. Among them, 19 patients had positive results of fungi on the PICC tips. The duration of antibiotics (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.02–1.31), parenteral nutrition infusion (OR 1.27, 95% CI 1.05–1.54), and postnatal glucocorticoid exposure (OR 9.48, 95% CI 1.06–84.98) were independent risk factors for fungal colonization in PICCs. The ROC curves showed that the risk increased after 15 days of antibiotic use and 28 days of parenteral nutrition infusion. Appropriate clinical management should be used to prevent fungal colonization and fungemia.

scholarly journals Prediction of anemia at delivery

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Enav Yefet ◽  
Avishag Yossef ◽  
Zohar Nachum
Keyword(s):  
Risk Factors ◽  
Operating Characteristic ◽  
Complete Blood Count ◽  
Characteristic Curve ◽  
Secondary Analysis ◽  
Area Under The Curve ◽  
Iron Supplement ◽  
Independent Risk Factors ◽  
Operating Characteristic Curve ◽  
Study Database

AbstractWe aimed to assess risk factors for anemia at delivery by conducting a secondary analysis of a prospective cohort study database including 1527 women who delivered vaginally ≥ 36 gestational weeks. Anemia (Hemoglobin (Hb) < 10.5 g/dL) was assessed at delivery. A complete blood count results during pregnancy as well as maternal and obstetrical characteristics were collected. The primary endpoint was to determine the Hb cutoff between 24 and 30 gestational weeks that is predictive of anemia at delivery by using the area under the curve (AUC) of the receiver operating characteristic curve. Independent risk factors for anemia at delivery were assessed using stepwise multivariable logistic regression. Hb and infrequent iron supplement treatment were independent risk factors for anemia at delivery (OR 0.3 95%CI [0.2–0.4] and OR 2.4 95%CI [1.2–4.8], respectively; C statistics 83%). Hb 10.6 g/dL was an accurate cutoff to predict anemia at delivery (AUC 80% 95%CI 75–84%; sensitivity 75% and specificity 74%). Iron supplement was beneficial to prevent anemia regardless of Hb value. Altogether, Hb should be routinely tested between 24 and 30 gestational weeks to screen for anemia. A flow chart for anemia screening and treatment during pregnancy is proposed in the manuscript.Trial registration: ClinicalTrials.gov Identifier: NCT02434653.

scholarly journals Prognostic significance of urine paraquat concentrations of patients with acute paraquat poisoning on admission at the emergency department

2018 ◽  
Vol 25 (1) ◽  
pp. 3-11 ◽  
Author(s):  
Xiaowei Liu ◽  
Tao Ma ◽  
Zhi Liu
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Receiver Operating Characteristic ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Prognostic Significance ◽  
Urine Concentration ◽  
Paraquat Poisoning ◽  
Independent Risk Factors ◽  
Receiver Operating

Objective: To assess the prognostic significance of urine paraquat concentrations of patients with acute paraquat poisoning on admission at the emergency department. Methods: Patients with acute paraquat poisoning admitted to the emergency department were recruited. Survivors and non-survivors were compared with regard to urinary paraquat concentration. The urinary level predictive of mortality was assessed by receiver operating characteristic curve. Risk factors of mortality were evaluated by regression analysis. Results: The overall mortality rate was 70.9% over the 28-day follow-up period. There was a significant difference in the urine paraquat concentrations recorded on admission between non-surviving and surviving patients ( p = 0.022). Receiver operating characteristic curve analysis revealed that the area under the curve when applied to receiver operating characteristic of the admission urine paraquat concentrations for predicting mortality was 0.854 with a cut-off value of 34.5 µg/mL. The dose of paraquat ingested, arterial lactate, and urine concentration were independent risk factors predicting 28-day mortality. The time interval between ingestion and hemoperfusion, arterial lactate, and urine concentration of paraquat were independent risk factors predicting acute kidney injury, while the partial pressure of carbon dioxide (PaCO2) and urine concentration of paraquat were independent risk factors predicting acute lung injury. Conclusion: The urine concentrations of paraquat on admission at emergency department demonstrated predictive ability for the prognosis of patients with acute paraquat poisoning.

scholarly journals Epidemiology, risk factors and outcomes of Candida albicans vs. non-albicans candidaemia in adult patients in Northeast China

2019 ◽  
Vol 147 ◽  
Author(s):  
Wei Zhang ◽  
Xingpeng Song ◽  
Hao Wu ◽  
Rui Zheng
Keyword(s):  
Risk Factors ◽  
Antifungal Agents ◽  
Multivariate Analyses ◽  
Urinary Catheter ◽  
Bloodstream Infections ◽  
Tertiary Hospital ◽  
Adult Patients ◽  
Increased Risk ◽  
Independent Risk Factors ◽  
Isolated Species

Abstract This study aimed to evaluate the clinical characteristics, risk factors and outcomes of adult patients with candidaemia caused by C. albicans vs. non-albicans Candida spp. (NAC). All adult hospitalised cases of candidaemia (2012–2017) at a tertiary hospital in Shenyang were included in the retrospective study, and a total of 180 episodes were analysed. C. parapsilosis was the most frequently isolated species (38.3%), followed by C. albicans (35.6%), C. glabrata (13.9%), C. tropicalis (10%) and others (2.2%). As initial antifungal therapy, 75.0%, 3.9%, 5.6% and 2.2% of patients received fluconazole, caspofungin, micafungin and voriconazole, respectively. Multivariate analyses revealed that total parenteral nutrition was associated with an increased risk of NAC bloodstream infections (BSI) (OR 2.535, 95% CI (1.066–6.026)) vs. C. albicans BSI. Additionally, the presence of a urinary catheter was associated with an increased risk of C. albicans BSI (OR 2.295 (1.129–4.666)) vs. NAC BSI. Moreover, ICU stay (OR 4.013 (1.476–10.906)), renal failure (OR 3.24 (1.084–9.683)), thrombocytopaenia (OR 7.171 (2.152–23.892)) and C. albicans (OR 3.629 (1.352–9.743)) were independent risk factors for candidaemia-related 30-day mortality, while recent cancer surgery was associated with reduced mortality risk (OR 26.479 (2.550–274.918)). All these factors may provide useful information to select initial empirical antifungal agents.

Bleeding, thrombosis and transfusion in patients on ECMO: A retrospective study in a tertiary center in Hong Kong

2020 ◽  
pp. 039139882096558
Author(s):  
Ka Man Fong ◽  
Shek Yin Au ◽  
George Wing Yiu Ng ◽  
Anne Kit Hung Leung
Keyword(s):  
Risk Factors ◽  
Bloodstream Infection ◽  
Primary Outcome ◽  
Significant Risk ◽  
Tertiary Hospital ◽  
Chinese Patients ◽  
Bleeding Complications ◽  
Bleeding Events ◽  
Tertiary Center ◽  
Independent Risk Factors

Purpose: Use of anticoagulation in patients on ECMO, especially in Chinese, has always been difficult. This study aimed to review the incidence of bleeding, thrombosis, and transfusion requirement in Chinese ECMO patients and to identify risk factors for bleeding complications. Materials and Methods: This was a retrospective observational study of a tertiary hospital from 2010 to 2018. Patients aged ⩾18 years who received ECMO were included. The primary outcome was incidence of bleeding. Secondary outcomes included ICU mortality, hospital mortality, and length of the ICU and hospital stay. Results: Of the 130 patients, 55(42.3%) had at least one bleeding events and thrombosis occurred in 37(28.5%). A lower fibrinogen level (adjusted OR 0.56 (0.36–0.86), p = 0.009), bloodstream infection (adjusted OR 2.76 (1.01–7.53), p = 0.047) and longer duration on ECMO (adjusted OR 1.14 (1.02–1.27), p = 0.018) were independently associated with occurrence of bleeding. APTT (adjusted OR 0.99 (0.97–1.01), p = 0.370) and platelet count (adjusted OR 1.00 (0.98–1.01), p = 0.632) were not statistically significant risk factors for bleeding events. Conclusions: Bleeding and thrombosis were common complications in Chinese patients receiving ECMO. Hypofibrinogenemia and bloodstream infection, but not APTT nor platelet counts, were independent risk factors for bleeding events.

scholarly journals Risk Factors of Early Postoperative Bowel Obstruction for Patients Undergoing Selective Colorectal Surgeries

2021 ◽  
Author(s):  
Shuguang Yang ◽  
Zhidong Gao ◽  
Huiying Zhao ◽  
Youzhong An ◽  
Jianghui Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Bowel Obstruction ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Peking University ◽  
Independent Risk Factors ◽  
Operating Characteristic Curve ◽  
The Stability ◽  
Postoperative Feeding

Abstract Objective: Postoperative bowel obstruction was one of the most severe complications in patients received colorectal surgeries. The aim of this study was to explore risk factors of early postoperative obstruction and to construct a nomogram to predict the possibility of occurrence. Methods: The records of 1437 patients who underwent selective colorectal surgery in Peking University People’s Hospital from 2015 to 2020 was retrospectively collect. Risk factors of early postoperative bowel obstruction were identified by logistic regression analysis and a nomogram was then constructed. Bootstrap was applied to verify the stability of the model. Results: COPD, hypothyroidism, probiotic indications, duration of antibiotics, and time to postoperative feeding were identified as independent risk factors and were put into a nomogram for predicting early postoperative bowel obstruction. The nomogram showed a robust discrimination, with area under the receiver operating characteristic curve was 0.894 and was well calibrated. Conclusion: A nomogram including independent risk factors of COPD, hypothyroidism, probiotic indications, duration of antibiotics, and time to postoperative feeding were established to predict the risk of early postoperative bowel obstruction.

scholarly journals Clinical and Microbiological Analysis of Risk Factors for Mortality in Patients With Carbapenem-Resistant Acinetobacter baumannii Bacteremia

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Hyo-Ju Son ◽  
Eun Been Cho ◽  
Moonsuk Bae ◽  
Seung Cheol Lee ◽  
Heungsup Sung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acinetobacter Baumannii ◽  
Multivariable Analysis ◽  
Tertiary Hospital ◽  
Source Control ◽  
Microbiological Analysis ◽  
Clinical Factors ◽  
Carbapenem Resistant ◽  
Infection Source ◽  
Independent Risk Factors

Abstract Background Carbapenem-resistant Acinetobacter baumannii (CRAB) infection is associated with significant mortality, causing worldwide concern, yet there are limited data on contributing microbiological factors. This study aimed to identify the clinical and microbiologic risk factors for mortality in CRAB bacteremia. Methods Adult patients with monomicrobial CRAB bacteremia in a 2700-bed tertiary hospital between December 2012 and December 2018 were retrospectively enrolled. Risk factors for 30-day mortality were evaluated. All isolates collected on the first day of bacteremia were subjected to colistin susceptibility testing by broth microdilution and to genotyping by multilocus sequence typing. Results A total of 164 patients were enrolled, and 90 (55%) died within 30 days. The most common genotype among the isolates was ST191 (49%), and 12 isolates (7%) were resistant to colistin. Genotype, colistin minimum inhibitory concentration, and colistin resistance were not significantly associated with mortality, in contrast to several clinical factors. In multivariable analysis, ineradicable or not-eradicated focus (adjusted odds ratio [aOR], 4.92; 95% CI, 1.95–12.42; P = .001), septic shock (aOR, 4.72; 95% CI, 2.12–10.49; P &lt; .001), and inappropriate antimicrobial therapy (aOR, 2.54; 95% CI, 1.05–6.16; P = .04) were independent risk factors for mortality. Among antibiotic strategies, colistin combined with tigecycline or other antibiotics were significantly associated with lower mortality after adjustment for confounding factors. Conclusions Clinical factors such as the nature of the infection source and source control, severity of bacteremia, and appropriateness of antibiotics, rather than microbiological factors, contribute to mortality in CRAB bacteremia. A specific antibiotic combination may help improve outcomes.

scholarly journals Prognostic Value of Adrenomedullin and Natriuretic Peptides in Uroseptic Patients Induced by Ureteroscopy

2016 ◽  
Vol 2016 ◽  
pp. 1-10
Author(s):  
Wei Hu ◽  
Pang-hu Zhou ◽  
Wei Wang ◽  
Lijun Zhang ◽  
Xiao-bin Zhang
Keyword(s):  
Risk Factors ◽  
Natriuretic Peptides ◽  
Ureteral Obstruction ◽  
Prognostic Value ◽  
Operating Characteristic ◽  
Plasma Concentrations ◽  
Unilateral Ureteral Obstruction ◽  
Stone Size ◽  
Brain Natriuretic Peptides ◽  
Independent Risk Factors

The aim of this paper is to investigate whether urosepsis is related to irrigation pressure of ureteroscopy (URS) and evaluate the prognostic value of adrenomedullin (ADM) and atrial and brain natriuretic peptides (ANP and BNP) in URS-induced uroseptic patients. From July 2008 to October 2013, we enrolled 332 patients with untreated unilateral ureteral obstruction (UUO). The UUO group included three subgroups of, respectively, 118, 132, and 82 patients who underwent URS under intermittent stable irrigation pressure of, respectively, 80, 120, and 160 mmHg. The plasma concentrations of ADM, ANP, and BNP were measured in all subjects. URS was performed for all UUO patients; the values of the three peptides were measured again after URS. Irrigation pressure and stone size were independent risk factors of urosepsis. After URS, the plasma concentrations of ADM, ANP, and BNP were significantly higher in uroseptic patients. Moreover, the concentrations were significantly higher depending on the disease severity. Plasma concentrations of the three peptides were correlated with plasma ET concentration in the uroseptic patients. The areas under receiver operating characteristic (ROC) curve of ADM, ANP, and BNP for predicting urosepsis were 0.811, 0.728, and 0.764, respectively. In conclusion, ADM, along with ANP and BNP, is valuable for prognosis in urosepsis secondary to URS which is associated with irrigation pressure.

scholarly journals Increasing Newly Diagnosed Inflammatory Bowel Disease and Improving Prognosis in China: A 30-year Retrospective Study From a Single Center

2020 ◽  
Author(s):  
Hong Lv ◽  
Meng Jin ◽  
Huimin Zhang ◽  
Xuanfu Chen ◽  
Meixu Wu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Pearson Correlation ◽  
Cohort Analysis ◽  
Tertiary Hospital ◽  
Intestinal Fistula ◽  
Multivariable Logistic Regression Analysis ◽  
Newly Diagnosed ◽  
College Hospital ◽  
Independent Risk Factors

Abstract Background: We aimed to characterize the trends of prognosis in Ulcerative Colitis (UC) and Crohn’s Disease (CD) in a Chinese tertiary hospital. Methods: A 30-year retrospective cohort analysis was conducted at Peking Union Medical College Hospital. Consecutive patients newly diagnosed with UC or CD from 1985 to 2014 were included. The primary outcome was in-hospital mortality. Second outcomes included surgery and length of stay in hospital. Pearson correlation coefficient was performed to determine the relationship between time and prognosis. Multivariable logistic regression analysis was performed to determine the risk factors for in-hospital mortality and surgery. Results: In total, 1467 patients were included in this study (898 cases with UC and 569 cases with CD). Annual admissions of UC and CD rose significantly over the last 30 years (UC, r=0.918, P<0.05; CD, r=0.898, P<0.05). Decreased in-hospital mortalities were observed in patients with UC and CD (UC, from 2.44% to 0.27%, r=-0.827, P<0.05; CD, from 12.50% to 0.00%, r=-0.978, P<0.05). A decreasing surgery rate was observed in patients with CD (r=-0.847, P<0.05) while an increasing surgery rate was observed in patients with UC (r=0.956, P<0.05). Shortened average lengths of stay in hospital were observed both in patients with UC and CD (UC, from 47.83±34.35 days to 23.58±20.05 days, r=-0.970, P<0.05; CD, from 65.50±50.57days to 26.41±18.43 days, r=-0.913, P<0.05). Toxic megacolon, sepsis shock were independent risk factors for in-hospital mortality in patients with UC. Intestinal fistula, intestinal perforation were independent risk factors for in-hospital mortality in patients with CD. Conclusions: In this cohort, the admissions of patients with UC and CD were increased with a significantly improved prognosis during past 30 years.

scholarly journals Risk factors of early postoperative bowel obstruction for patients undergoing selective colorectal surgeries

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shuguang Yang ◽  
Huiying Zhao ◽  
Jianhui Yang ◽  
Youzhong An ◽  
Hua Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Bowel Obstruction ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Elective Colorectal Surgery ◽  
Peking University ◽  
Independent Risk Factors ◽  
Operating Characteristic Curve ◽  
The Stability ◽  
Postoperative Feeding

Abstract Objective Postoperative bowel obstruction was one of the most severe complications in patients who received colorectal surgeries. This study aimed to explore risk factors of early postoperative obstruction and to construct a nomogram to predict the possibility of occurrence. Methods The records of 1437 patients who underwent elective colorectal surgery in Peking University People’s Hospital from 2015 to 2020 were retrospectively collected. Risk factors of early postoperative bowel obstruction were identified by logistic regression analysis and a nomogram was then constructed. Bootstrap was applied to verify the stability of the model. Results COPD, hypothyroidism, probiotic indications, duration of antibiotics, and time to postoperative feeding were identified as independent risk factors and were put into a nomogram for predicting early postoperative bowel obstruction. The nomogram showed robust discrimination, with the area under the receiver operating characteristic curve was 0.894 and was well-calibrated. Conclusion A nomogram including independent risk factors of COPD, hypothyroidism, probiotic indications, duration of antibiotics, and time to postoperative feeding were established to predict the risk of early postoperative bowel obstruction.

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