scholarly journals Risk Factors for Acquiring Multi-Drug Resistant Klebsiella Pneumoniae At A Tertiary Teaching Hospital in China

2021 ◽  
Author(s):  
Weidong Zhang ◽  
Yuan Gao ◽  
Shuo Huang ◽  
Anhua Wu ◽  
chenchao fu
Keyword(s):  
Risk Factors ◽  
Klebsiella Pneumoniae ◽  
Hospital Stay ◽  
Multivariate Logistic Regression Analysis ◽  
Drainage Tube ◽  
Time Interval ◽  
Drug Resistant ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital ◽  
Independent Risk Factors

Abstract BACKGROUD To analyze the risk factors for acquiring multi-drug resistant Klebsiella pneumoniae (MDR-Kpn). METHODS Data were collected from patients who were admitted into a tertiary teaching hospital in China from January 2018 to October 2020. Sensitive Klebsiella pneumoniae (Kpn) was detected in 82 patients. After a period of treatment, 41 patients were detected with MDR-Kpn, and they were designed as the MDR-Kpn group. Another 41 patients always detected with sensitive Klebsiella pneumoniae were assigned to the sensitive Kpn group. The baseline characteristics and clinical parameters were compared between these two groups. Multivariate logistic regression analysis were conducted to determine the risk factors for acquiring MDR-Kpn. RESULTS The proportion of sex, history of smoking and department distribution had no significant differences between these two groups. However, the patients with chronic pulmonary diseases and neurological disorders were more likely to acquire MDR-Kpn. It also showed longer hospital stay before the first detection of multi-drug resistant Kpn in MDR-Kpn group than the hospital stay before the last detection of sensitive-Kpn in sensitive Kpn group. Additionally, days of hospitalization, ICU stay, days of drainage tube use, times of sputum suction, days of foley catheter use, days of vascular catheter use between the twice detection (it represents the time interval between first detection of sensitive-Kpn to first detection of resistant-Kpn in MDR-Kpn group, and also represents the time interval between first detection of sensitive-Kpn to last detection of sensitive-Kpn in sensitive Kpn group), were higher in MDR-Kpn group. The results showed more categories of antimicrobials in patients of acquiring MDR-Kpn, along with more days of using broad-spectrum cephalosporins, fluoroquinolones and glycylcyclines, compared to non-transition group. Multivariate logistic regression analysis showed that the number of comorbidities, hospital stay before the first detection of multidrug-resistan Kpn (MDR-Kpn group) or last detection of sensitive Kpn (Sensitive group), days of using drainage tube and number of antimicrobial categories between the two detection were independent risk factors of acquiring multidrug-resistance for Kpn. CONCLUSION: The number of comorbidities, the hospital stay, the number of antimicrobial categories, and days of using drainage tube were independent risk factors for acquiring MDR-Kpn.

A Retrospective Analysis of Risk Factors and Outcomes of Carbapenem-Resistant Klebsiella pneumoniae Bacteremia in Nontransplant Patients

2020 ◽  
Vol 221 (Supplement_2) ◽  
pp. S174-S183
Author(s):  
Tingting Xiao ◽  
Yunying Zhu ◽  
Shuntian Zhang ◽  
Yuan Wang ◽  
Ping Shen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Klebsiella Pneumoniae ◽  
Multivariate Logistic Regression Analysis ◽  
Severe Illness ◽  
Poor Clinical Outcome ◽  
Carbapenem Resistant ◽  
Definitive Therapy ◽  
New Ideas ◽  
Independent Risk Factors ◽  
Microbiological Data

Abstract Background Carbapenem-resistant Klebsiella pneumoniae (CRKP) has become a major problem among nosocomial infections, and it is a serious threat to patients. The clinical characteristics and outcome of CRKP bloodstream infection (BSI) in nontransplant patients remains unelucidated. The aim of this study was as follows: identify the risk factors of CRKP infection; generate new ideas for prevention; and generate new ideas for the most effective therapeutic management in nontransplant patients. Methods The study retrospectively analyzed the clinical and microbiological data of nontransplant patients with K pneumoniae (KP) bacteremia from January 2013 to December 2015 to identify risk factors, clinical features, and outcomes using multivariate logistic regression analysis. Results Of the 371 patients with KP-BSI in nontransplant patients included in this study, 28.0% (N = 104) had CRKP. The 28-day mortality was higher in patients infected with CRKP (55.8%) than in those with carbapenem-susceptible KP (13.9%) (P < .001). Multivariate analysis showed previous gastric catheterization, previous use of carbapenems, hypoproteinemia, and high Acute Physiologic Assessment and Chronic Health Evaluation II scores as independent risk factors for CRKP-BSIs. Carbapenem-resistant KP infection, severe illness, and tigecycline therapy were independent risk factors for death from KP-BSIs. Taken together, inappropriate antibiotic treatment both in empirical and definitive therapy and imipenem minimum inhibitory concentrations (MICs) of >8 mg/L were associated with poor clinical outcome. Conclusions Nontransplant patients with CRKP-BSI had higher mortality. Carbapenems exposure was an independent risk factor for CRKP infection. Imipenem MICs of >8 mg/L, tigecycline therapy, and inappropriate treatments increased the 28-day mortality of KP-BSI patients.

scholarly journals Prediction of prolonged mechanical ventilation in critically ill obstetric patients: Ten years of data from a tertiary teaching hospital in mainland China

2020 ◽  
Author(s):  
Huiying Zhao ◽  
Guangjie Wang ◽  
Jie Lyu ◽  
Xiaohong Zhang ◽  
Youzhong An
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Critically Ill ◽  
Myocardial Injury ◽  
Prolonged Mechanical Ventilation ◽  
Mainland China ◽  
Estimated Blood Loss ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital ◽  
Independent Risk Factors

Abstract Background: Maternal admission to the intensive care unit (ICU) during pregnancy or in the postpartum period is a marker of severe acute maternal morbidity. Mechanical ventilation is an important and basic method of maintaining life support in the ICU, but prolonged mechanical ventilation (PMV) is associated with a prolonged length of hospital stay and other adverse outcomes. Therefore, we conducted this retrospective study to describe morbidity and further try to identify the risk factors for PMV in critically ill obstetric women.Methods: The clinical data were obtained from a single-centre retrospective comparative study of 143 critically ill obstetric patients at a tertiary teaching hospital in mainland China between January 1, 2009, and December 31, 2019. Clinical and obstetric parameters were collected to analyse the risk factors for PMV. Patients were separated into groups with and without PMV. Potential risk factors were identified by univariate testing. Multivariate logistic regression was used to evaluate independent predictors of PMV.Results: Out of 29,236 hospital deliveries, 265 critically ill obstetric patients entered the ICU. One hundred forty-five (54.7%) of them were treated with mechanical ventilation. Two were excluded because of death within 24 hours. Sixty-five critically ill obstetric patients (45.5%) underwent PMV. The independent risk factors for PMV included estimated blood loss (odds ratio (OR) =1.296, P=0.029), acute kidney injury (AKI) (OR=4.305, P=0.013), myocardial injury (OR=4.586, P=0.012), and PaO2/FiO2 (OR=0.989, P<0.001). The area under the receiver operating characteristic (ROC) curve based on the predicted probability of the logistic regression was 0.934.Conclusions: Estimated blood loss, AKI, myocardial injury, and PaO2/FiO2 were independent risk factors for PMV in critically ill obstetric patients.

scholarly journals Prognostic role of time to positivity of blood culture in children with Pseudomonas aeruginosa bacteremia.

2020 ◽  
Author(s):  
huiting xu ◽  
Jie Cheng ◽  
Qinghong Yu ◽  
Qingyuan Li ◽  
Qian Yi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Pseudomonas Aeruginosa ◽  
Blood Culture ◽  
Hospital Mortality ◽  
Time To Positivity ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital ◽  
Independent Risk Factors

Abstract Background: Pseudomonas aeruginosa (P. aeruginosa) is a major Gram-negative pathogen, which has been reported to result in high mortality. We aim to investigate the prognostic value and optimum cut-off point of time-to-positivity (TTP) of blood culture in children with P. aeruginosa bacteremia.Methods: From August 2014 to November 2018, we enrolled the inpatients with P. aeruginosa bacteremia in a 1500-bed tertiary teaching hospital in Chongqing, China retrospectively. Receiver operating characteristic (ROC) analysis was used to determine the optimum cut-off point of TTP, and logistic regression were employed to explore the risk factors for in-hospital mortality and septic shock.Results: Totally, 52 children with P. aeruginosa bacteremia were enrolled. The standard cut-off point of TTP was18 hours. Early TTP (≤18 hours) group patients had remarkably higher in-hospital mortality (42.9% vs 9.7%, P=0.014), higher incidence of septic shock (52.4% vs12.9%, P=0.06), higher Pitt bacteremia scores [3.00 (1.00-5.00) vs 1.00 (1.00-4.00), P=0.046] and more intensive care unit admission (61.9% vs 22.6%, P=0.008) when compared with late TTP (>18 hours) groups. Multivariate analysis indicated TTP ≤18 h, Pitt bacteremia scores ≥4 were the independent risk factors for in-hospital mortality (OR 5.88, 95%CI 1.21-21.96, P=0.035; OR 4.95, 95%CI 1.26-27.50, P=0.024; respectively). The independent risk factors for septic shock were as follows: TTP ≤18h, Pitt bacteremia scores ≥4 and hypoalbuminemia (OR 6.30, 95%CI 1.18-33.77, P=0.032; OR 8.15, 95%CI 1.15-42.43, P=0.014; OR 6.46, 95% CI 1.19-33.19 P=0.031; respectively).Conclusions: Early TTP (≤18 hours) appeared to be associated with worse outcomes for P. aeruginosa bacteremia children.Trial registration: Retrospectively registered. File No. (2019)304

scholarly journals Prognostic role of time to positivity of blood culture in children with Pseudomonas aeruginosa bacteremia

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Huiting Xu ◽  
Jie Cheng ◽  
Qinghong Yu ◽  
Qingyuan Li ◽  
Qian Yi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Pseudomonas Aeruginosa ◽  
Blood Culture ◽  
Hospital Mortality ◽  
Time To Positivity ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital ◽  
Independent Risk Factors

Abstract Background Pseudomonas aeruginosa (P. aeruginosa) is a major Gram-negative pathogen, which has been reported to result in high mortality. We aim to investigate the prognostic value and optimum cut-off point of time-to-positivity (TTP) of blood culture in children with P. aeruginosa bacteremia. Methods From August 2014 to November 2018, we enrolled the inpatients with P. aeruginosa bacteremia in a 1500-bed tertiary teaching hospital in Chongqing, China retrospectively. Receiver operating characteristic (ROC) analysis was used to determine the optimum cut-off point of TTP, and logistic regression were employed to explore the risk factors for in-hospital mortality and septic shock. Results Totally, 52 children with P. aeruginosa bacteremia were enrolled. The standard cut-off point of TTP was18 h. Early TTP (≤18 h) group patients had remarkably higher in-hospital mortality (42.9% vs 9.7%, P = 0.014), higher incidence of septic shock (52.4% vs12.9%, P = 0.06), higher Pitt bacteremia scores [3.00 (1.00–5.00) vs 1.00 (1.00–4.00), P = 0.046] and more intensive care unit admission (61.9% vs 22.6%, P = 0.008) when compared with late TTP (> 18 h) groups. Multivariate analysis indicated TTP ≤18 h, Pitt bacteremia scores ≥4 were the independent risk factors for in-hospital mortality (OR 5.88, 95%CI 1.21–21.96, P = 0.035; OR 4.95, 95%CI 1.26–27.50, P = 0.024; respectively). The independent risk factors for septic shock were as follows: TTP ≤18 h, Pitt bacteremia scores ≥4 and hypoalbuminemia (OR 6.30, 95%CI 1.18–33.77, P = 0.032; OR 8.15, 95%CI 1.15–42.43, P = 0.014; OR 6.46, 95% CI 1.19–33.19 P = 0.031; respectively). Conclusions Early TTP (≤18 hours) appeared to be associated with worse outcomes for P. aeruginosa bacteremia children.

scholarly journals Prognostic role of time to positivity of blood culture in children with Pseudomonas aeruginosa bacteremia.

2020 ◽  
Author(s):  
huiting xu ◽  
Jie Cheng ◽  
Qinghong Yu ◽  
Qingyuan Li ◽  
Qian Yi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Pseudomonas Aeruginosa ◽  
Blood Culture ◽  
Hospital Mortality ◽  
Time To Positivity ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital ◽  
Independent Risk Factors

Abstract Background Pseudomonas aeruginosa ( P. aeruginosa ) is a major Gram-negative pathogen, which has been reported to result in high mortality. We aim to investigate the prognostic value and optimum cut-off point of time-to-positivity (TTP) of blood culture in children with P. aeruginosa bacteremia. Methods From August 2014 to November 2018, we enrolled the inpatients with P. aeruginosa bacteremia in a 1500-bed tertiary teaching hospital in Chongqing, China retrospectively. 52 case were analyzed. Receiver operating characteristic (ROC) analysis was used to determine the optimum cut-off point of TTP, and logistic regression were employed to explore the risk factors for in-hospital mortality and septic shock. Results Totally, 52 children with P. aeruginosa bacteremia were enrolled. The standard cut-off point of TTP was18 hours. Early TTP (≤18 hours) group patients had remarkably higher in-hospital mortality (42.9% vs 9.7%, P=0.014), higher incidence of septic shock (52.4% vs 12.9%, P=0.06), higher Pitt bacteremia scores [3.00 (1.00-5.00) vs 1.00 (1.00-4.00), P=0.046] and more intensive care unit admission (61.9% vs 22.6%, P=0.008) when compared with late TTP (>18 hours) groups. Multivariate analysis indicated TTP ≤18 h, Pitt bacteremia scores ≥4 were the independent risk factors for in-hospital mortality (OR 5.88, 95%CI 1.21-21.96, P=0.035; OR 4.95, 95%CI 1.26-27.50, P=0.024; respectively). The study also revealed that the independent risk factors for septic shock were as follows: TTP≤18h, Pitt bacteremia scores≥4 and hypoalbuminemia (OR 6.30, 95%CI 1.18-33.77, P=0.032; OR 8.15, 95%CI 1.15-42.43, P=0.014; OR 6.46, 95% CI 1.19-33.19 P=0.031; respectively). Conclusions Early TTP (≤18 hours) appeared to be associated with worse outcomes for P. aeruginosa bacteremia children.

scholarly journals Prediction of mechanical ventilation greater than 24 hours in critically ill obstetric patients: Ten years of data from a tertiary teaching hospital in mainland China

2021 ◽  
Author(s):  
Huiying Zhao ◽  
Guangjie Wang ◽  
Jie Lyu ◽  
Xiaohong Zhang ◽  
Youzhong An
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Critically Ill ◽  
Myocardial Injury ◽  
Mainland China ◽  
Estimated Blood Loss ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital ◽  
Independent Risk Factors

Abstract Background: Maternal admission to the intensive care unit (ICU) during pregnancy or in the postpartum period is a marker of severe acute maternal morbidity. Mechanical ventilation is an important and basic method of maintaining life support in the ICU, but prolonged mechanical ventilation (PMV) is associated with a prolonged length of hospital stay and other adverse outcomes. Therefore, we conducted this retrospective study to describe morbidity and further try to identify the risk factors for PMV in critically ill obstetric women.Methods: The clinical data were obtained from a single-centre retrospective comparative study of 143 critically ill obstetric patients at a tertiary teaching hospital in mainland China between January 1, 2009, and December 31, 2019. PMV was defined as a mechanical ventilation length of more than 24 hours. Clinical and obstetric parameters were collected to analyse the risk factors for PMV. Patients were separated into groups with and without PMV. Potential risk factors were identified by univariate testing. Multivariate logistic regression was used to evaluate independent predictors of PMV.Results: Out of 29,236 hospital deliveries, 265 critically ill obstetric patients entered the ICU. One hundred forty-five (54.7%) of them were treated with mechanical ventilation. Two were excluded because of death within 24 hours. Sixty-five critically ill obstetric patients (45.5%) underwent PMV. The independent risk factors for PMV included estimated blood loss (odds ratio (OR) =1.296, P=0.029), acute kidney injury (AKI) (OR=4.305, P=0.013), myocardial injury (OR=4.586, P=0.012), and PaO2/FiO2 (OR=0.989, P<0.001). The area under the receiver operating characteristic (ROC) curve based on the predicted probability of the logistic regression was 0.934.Conclusions: Estimated blood loss, AKI, myocardial injury, and PaO2/FiO2 were independent risk factors for PMV in critically ill obstetric patients.

scholarly journals Prediction of prolonged mechanical ventilation in critically ill obstetric patients: Ten years of data from a tertiary teaching hospital in mainland China

2020 ◽  
Author(s):  
Huiying Zhao ◽  
Guangjie Wang ◽  
Jie Lyu ◽  
Xiaohong Zhang ◽  
Youzhong An
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Critically Ill ◽  
Myocardial Injury ◽  
Prolonged Mechanical Ventilation ◽  
Mainland China ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital ◽  
Independent Risk Factors

Abstract BackgroundMaternal admission to the intensive care unit (ICU) during pregnancy or in the postpartum period is a marker of severe acute maternal morbidity. Mechanical ventilation is an important and basic method of maintaining life support in the ICU, but prolonged mechanical ventilation (PMV) is associated with a prolonged length of hospital stay and other adverse outcomes. Therefore, we conducted this retrospective study to describe morbidity and further try to identify the risk factors for PMV in critically ill obstetric women.MethodsThe clinical data were obtained from a single-centre retrospective comparative study of 143 critically ill obstetric patients at a tertiary teaching hospital in mainland China between January 1, 2009, and December 31, 2019. Clinical and obstetric parameters were collected to analyse the risk factors for PMV. Patients were separated into groups with and without PMV. Potential risk factors were identified by univariate testing. Multivariate logistic regression was used to evaluate independent predictors of PMV.ResultsOut of 29,236 hospital deliveries, 265 critically ill obstetric patients entered the ICU. One hundred forty-five (54.7%) of them were treated with mechanical ventilation. Two were excluded because of death within 24 hours. Sixty-five critically ill obstetric patients (45.5%) underwent PMV. The independent risk factors for PMV included estimated blood loss (odds ratio (OR) = 1.296, P = 0.029), acute kidney injury (AKI) (OR = 4.305, P = 0.013), myocardial injury (OR = 4.586, P = 0.012), and PaO2/FiO2 (OR = 0.989, P < 0.001). The area under the receiver operating characteristic (ROC) curve based on the predicted probability of the logistic regression was 0.934.ConclusionsEstimated blood loss, AKI, myocardial injury, and PaO2/FiO2 were independent risk factors for PMV in critically ill obstetric patients.

scholarly journals Prediction of mechanical ventilation greater than 24 hours in critically ill obstetric patients: ten years of data from a tertiary teaching hospital in mainland China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Huiying Zhao ◽  
Guangjie Wang ◽  
Jie Lyu ◽  
Xiaohong Zhang ◽  
Youzhong An
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Logistic Regression ◽  
Critically Ill ◽  
Myocardial Injury ◽  
Mainland China ◽  
Estimated Blood Loss ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital ◽  
Independent Risk Factors

Abstract Background Maternal admission to the intensive care unit (ICU) during pregnancy or in the postpartum period is a marker of severe acute maternal morbidity. Mechanical ventilation is an important and basic method of maintaining life support in the ICU, but prolonged mechanical ventilation (PMV) is associated with a prolonged length of hospital stay and other adverse outcomes. Therefore, we conducted this retrospective study to describe morbidity and further try to identify the risk factors for PMV in critically ill obstetric women. Methods The clinical data were obtained from a single-centre retrospective comparative study of 143 critically ill obstetric patients at a tertiary teaching hospital in mainland China between January 1, 2009, and December 31, 2019. PMV was defined as a mechanical ventilation length of more than 24 h. Clinical and obstetric parameters were collected to analyse the risk factors for PMV. Patients were separated into groups with and without PMV. Potential risk factors were identified by univariate testing. Multivariate logistic regression was used to evaluate independent predictors of PMV. Results Out of 29,236 hospital deliveries, 265 critically ill obstetric patients entered the ICU. One hundred forty-five (54.7%) of them were treated with mechanical ventilation. Two were excluded because of death within 24 h. Sixty-five critically ill obstetric patients (45.5%) underwent PMV. The independent risk factors for PMV included estimated blood loss (odds ratio (OR) =1.296, P=0.029), acute kidney injury (AKI) (OR=4.305, P=0.013), myocardial injury (OR=4.586, P=0.012), and PaO2/FiO2 (OR=0.989, P< 0.001). The area under the receiver operating characteristic (ROC) curve based on the predicted probability of the logistic regression was 0.934. Conclusions Estimated blood loss, AKI, myocardial injury, and PaO2/FiO2 were independent risk factors for PMV in critically ill obstetric patients.

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