A longitudinal population-based study of predictors of mortality from bloodstream infections in Calgary, Alberta, Canada

2021 ◽  
Author(s):  
Deirdre Church ◽  
Ranjani Somayaji ◽  
Jeannine Viczko ◽  
Dan Gregson ◽  
Christopher Naugler

Aim: To study the predictors of mortality from nine major pathogens causing approximately 70% of cases over a 7-year period. Materials & methods: A population-based surveillance cohort of all adult and pediatric patients in the Calgary Zone with an initial episode of bloodstream infections (BSI). Results: The 1-year mortality was 29.2% among 9524 patients (5164 males [54%]). Incidence rates for BSI increased annually to 119.7/100,000 persons by 2016. Distinct survival curves were found for each specific pathogen. Age, comorbidity burden and infecting organism were significantly associated with increased hazard of death. No relationship occurred between the time to positivity for blood cultures and overall mortality. Conclusion: BSI has a high mortality, but overall survival depends on underlying host health and the type of pathogen acquired.

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S219-S220
Author(s):  
Elaha Niazi ◽  
Kwadwo Mponponsuo ◽  
Ranjani Somayaji ◽  
Elissa Rennert-May ◽  
John Conly ◽  
...  

Abstract Background Bloodstream infections (BSI) are a major cause of morbidity, mortality, and health care costs worldwide. Population-based studies are key to assess BSI epidemiology over time while minimizing selection bias but remain limited. Therefore, we aimed to assess the incidence of BSI in a large Canadian health region in a contemporary period. We hypothesized that there would be significant age and sex-based differences including over time. Methods We conducted a retrospective cohort study from 2011 through 2018 using a population-based microbiology database to determine the annual age- and sex-specific BSI testing and case rates with the census as the population reference. BSI was defined as a positive blood culture for a pathogen. Episodes > 30 days apart were included for analysis. Incidence rate ratios (IRR) for testing and case rates including by sex were calculated to assess changes over time. All analyses were run at a two-sided α of 0.05 and were conducted with R 4.0.4. Results A total of 154,147 distinct individuals (49.9% male) were analyzed and 22,869 (14.8%) had a BSI at the first encounter in the study period. Overall BSI testing incidence ranged from 1529 to 1707 per 100,000 person-years and case incidence ranged from 180 to 292 per 100,000 person-years. Testing and case incidence for BSI was greatest in the 0-4 and 75+ years age groups (p < 0.01). Males compared to females had greater testing and case incidence rates in young and old age groups, but females had greater rates in the 15-44 years groups (p < 0.01). Overall IRR for cases comparing 2018 to 2011 was 0.62 (95% CI 0.59-0.65) reflecting a significant decrease over time. Testing also decreased over the study period with an IRR of 0.90 (95% CI 0.88-0.91). Testing and case IRRs were not significantly different stratified by sex. Incidence rates (per 100,000 person-years) of BSI testing and cases by sex from 2011 through 2018 in a Canadian health region Conclusion In our large population-based study of BSI, we identified that BSI remain frequent and the youngest and oldest age groups as well as males in these age groups have the greatest BSI incidence rates which may reflect both biological sex and gender-based differences. Encouragingly, BSI incidence rates have decreased over time at a greater increment relative to testing rates. Future studies of BSI should focus on pathogen and outcome-based evaluations. Disclosures All Authors: No reported disclosures


Blood ◽  
2011 ◽  
Vol 117 (5) ◽  
pp. 1707-1709 ◽  
Author(s):  
Vittorio Pengo ◽  
Franco Noventa ◽  
Gentian Denas ◽  
Martino F. Pengo ◽  
Umberto Gallo ◽  
...  

Abstract Whether long-term use of vitamin K antagonists (VKAs) might affect the incidence of cancer is a longstanding hypothesis. We conducted a population-based study including all cancer- and thromboembolism-free patients of our health area; study groups were defined according to chronic anticoagulant use to VKA-exposed and control groups. Cancer incidence and cancer-related and overall mortality was assessed in both groups. 76 008 patients (3231 VKA-exposed and 72 777 control subjects) were followed-up for 8.2 (± 3.2) years. After adjusting for age, sex, and time-to-event, the hazard ratio of newly diagnosed cancer in the exposed group was 0.88 (95% confidence interval [95% CI] 0.80-0.98; P < .015). VKA-exposed patients were less likely to develop prostate cancer, 0.69 (95% CI 0.50-0.97; P = .008). The adjusted hazard ratio for cancer-related and overall mortality was 1.07 (95% CI 0.92-1.24) and 1.12 (95% CI 1.05-1.19), respectively. These results support the hypothesis that anticoagulation might have a protective effect on cancer development, especially prostate cancer.


2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S401-S401
Author(s):  
Jack McHugh ◽  
Talha Khawaja ◽  
Larry M Baddour ◽  
Larry M Baddour ◽  
Juan Crestanello ◽  
...  

Abstract Background Bloodstream infections (BSIs) confer an increased risk of infective endocarditis (IE) in patients with a prosthetic cardiac valve. This relationship is less well established in patients undergoing valve repair. We conducted a retrospective population-based study to determine the incidence of BSIs following valve repair and identify risk factors associated with the development of IE. Methods The Rochester Epidemiology Project (REP) data linkage system was used to identify all persons who underwent valve repair in a 7-county region in Southeastern Minnesota between January 1, 2010 and December 31, 2018. Medical records were screened for the development of a BSI from time of procedure until May 15, 2020. Patients were classified as having BSI only, BSI with IE at outset, or BSI with subsequent development of new IE. IE at outset was defined as cases where IE was diagnosed at the time of initial positive blood culture. Results A total of 387 patients underwent valve repair surgery. A total of 31 (8%) patients subsequently developed a BSI, 4% within one year of surgery. Seventeen patients underwent mitral repair with annuloplasty, 9 underwent tricuspid annuloplasty, and 5 had concurrent repairs. Median time to the development of BSI was 338 days. Of the 31 patients with BSI, 4 (13%) had BSI with IE at outset. No patients developed IE subsequent to BSI, Enterococcus spp. was responsible for 3 cases of IE, and MSSA for 1. All cases occurred within one year of surgery. Given the low incidence, statistical analysis of associated risk factors for IE was not feasible. All patients with BSI and IE at outset, however, died by the end of the study period, versus 11/27 in the BSI only group. Conclusion Incidence of BSIs was higher in patients undergoing cardiac valve repair than in the general population. The incidence of IE with a BSI was 13%, which is lower than what has been previously published. It is notable that all cases of IE occurred within one year of surgery. Recognizing that endothelialization of device surfaces occurs, it is tempting to speculate that the risk of IE may be time dependent and may decline over time. Subsequent investigation of this theory is underway. Disclosures Larry M. Baddour, MD, Boston Scientific (Consultant)


2020 ◽  
Vol 6 (3) ◽  
pp. 205521732094776
Author(s):  
Anna Castelo-Branco ◽  
Flaminia Chiesa ◽  
Camilla E Bengtsson ◽  
Sally Lee ◽  
Neil N Minton ◽  
...  

Background Comorbidity is of significant concern in multiple sclerosis (MS). Few population-based studies have reported conditions occurring in MS after diagnosis, especially in contemporary cohorts. Objective To explore incident comorbidity, mortality and hospitalizations in MS, stratified by age and sex. Methods In a Swedish population-based cohort study 6602 incident MS patients (aged ≥18 years) and 61,828 matched MS-free individuals were identified between 1 January 2008 and 31 December 2016, using national registers. Incidence rates (IRs) and incidence rate ratios (IRRs) with 95% CI were calculated for each outcome. Results IRs of cardiovascular disease (CVD) were higher among MS patients than MS-free individuals, (major adverse CVD: IRR 1.42; 95% CI 1.12–1.82; hemorrhagic/ischemic stroke: 1.46; 1.05–2.02; transient ischemic attack: 1.65; 1.09–2.50; heart failure: 1.55; 1.15–2.10); venous thromboembolism: 1.42; 1.14–1.77). MS patients also had higher risks of several non-CVDs such as autoimmune conditions (IRR 3.83; 3.01–4.87), bowel dysfunction (2.16; 1.86–2.50), depression (2.38; 2.11–2.68), and fractures (1.32; 1.19–1.47), as well as being hospitalized and to suffer from CVD-related deaths ((1.91; 1.00–3.65), particularly in females (3.57; 1.58–8.06)). Conclusion MS-patients experience a notable comorbidity burden which emphasizes the need for integrated disease management in order to improve patient care and long-term outcomes of MS.


Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 1605-1605
Author(s):  
Malin Hultcrantz ◽  
Therese M-L Andersson ◽  
Ola Landgren ◽  
Paul W Dickman ◽  
Bjorn Andreasson ◽  
...  

Abstract Background The Myeloproliferative neoplasms (MPNs) consists of the subtypes polycythemia vera (PV), essential thrombocythemia (ET), primary myelofibrosis (PMF), and MPN unclassifiable (MPN-U). The incidence rates of these diseases vary substantially between different reports, ranging from 1.15 to 4.99/100,000 person-years. However, in a recent metaanalysis, there was no significant difference in MPN incidence between Europe and North America and the variations in incidence may therefore reflect the quality of the cancer registers and reporting of MPNs. In addition, there is a limited number of reports on MPN incidence during more recent years. Therefore, we assessed the incidence of MPN based on the Swedish Cancer Register, a high-quality population-based cancer register between 2000 and 2012. Patients and Methods The Swedish Cancer Register was used to identify all patients diagnosed with an MPN between January 1st 2000 and December 31st 2012. These Swedish Cancer Registers have very high levels of quality and completeness. Between 2008 and 2012, the reporting of newly diagnosed MPN to the cancer register was >92%. Information on the Swedish population was obtained from the Human Mortality Database (www.mortality.org). Based on information from these registers, incidence rates of MPNs with 95% confidence intervals (CIs) were calculated. Confidence intervals were estimated on the log scale. In addition, the incidence rate in relation to MPN subtype, age group (18-39, 40-49, 50-59, 60-69, 70-79, and ³80 years), as well as calendar year of diagnosis was assessed. Results A total of 5,442 MPN patients were reported to the cancer register between 2000 and 2012. During these years, there were 1,810 incident cases of PV, 1,862 of ET, 636 of PMF, and 1,134 with MPN-U. Between January 1st 2000 and December 31st 2012, the population in Sweden increased from 8,861,426 to 9,555,893 inhabitants. The overall annual incidence rate of MPN was 5.83 (95% CI 5.68-5.99)/100,000 persons. The incidence rate of PV was 1.94 (1.85-2.03), ET 2.00 (1.91-2.09), PMF 0.68 (0.63-0.74), and MPN-U 1.22 (1.15-1.29) per 100,000 person-years. In addition, there was a strong correlation between age and incidence of MPN with incidence rates being substantially higher among the older age groups (Table). The overall incidence rate of MPNs increased during the study period, from 5.06 (4.55-5.62)/100,000 person-years in the year 2000 to 5.98 (5.45-6.55)/100,000 person-years in 2012. The incidence rate of PV was similar throughout the study period, the incidence was 2.05 (1.74-2.42)/100,000 person-years in 2000 and 2.12 (1.81-2.47)/100,000 person-years in 2012. The annual incidence rate of ET and PMF increased, from 1.62 (1.34-1.95) to 2.49 (2.15-2.87) per 100,000 persons for ET and from 0.36 (0.24-0.53) to 0.86 (0.67-1.10) per 100,000 persons for PMF between 2000 and 2012. Conversely, the incidence of MPN-U decreased, 1.03 (0.81-1.29) to 0.52 (0.38-0.71)/100,000 person-years between 2000 and 2012. Summary and Conclusions In this large population-based study, the incidence of MPN was higher than previously reported in both European and North American studies. As earlier lower incidence rates likely are an effect of limited coverage of cancer registers, there may be an underreporting of MPNs in many European and American countries. The increase in MPN incidence rates during the study period may reflect increasing life expectancy of the Swedish population, improved reporting to the cancer register as well as changes in the classification and diagnostic systems. Similarly, the decrease in incidence of MPN-U is also likely a result of improved diagnostics during more recent years. In conclusion, the MPN incidences rates reported here are presumably more accurate compared to earlier reports due to the high level of coverage and accuracy of the Swedish registers. Table 1. Incidence rates of MPNs overall and in relation to subtype and age at diagnosis Total number MPN diagnosed 2000-2012 Incidence/100 000 person-years (95% confidence interval) All MPN 5,442 5.83 (5.68-5.99) Subtype PV 1,810 1.94 (1.85-2.03) ET 1,862 2.00 (1.91-2.09) PMF 636 0.68 (0.63-0.74) MPN-U 1,134 1.22 (1.15-1.29) Age at diagnosis (years) 18-39 226 0.67 (0.59-0.76) 40-49 361 2.26 (2.04-2.51) 50-59 769 4.92 (4.58-5.28) 60-69 1,228 9.54 (9.02-10.1) 70-79 1,680 18.99 (18.1-19.9) >80 1,178 18.92 (17.87-20.03) Disclosures Landgren: BMJ Publishing: Honoraria; Bristol-Myers Squibb: Honoraria; Medscape: Honoraria; Onyx: Honoraria; Celgene: Honoraria; International Myeloma Foundation: Research Funding; Medscape: Consultancy; BMJ Publishing: Consultancy; Onyx: Research Funding; Bristol-Myers Squibb: Consultancy; Onyx: Consultancy; Celgene: Consultancy.


2015 ◽  
Vol 173 (5) ◽  
pp. 655-664 ◽  
Author(s):  
Tomas Thor Agustsson ◽  
Tinna Baldvinsdottir ◽  
Jon G Jonasson ◽  
Elinborg Olafsdottir ◽  
Valgerdur Steinthorsdottir ◽  
...  

ObjectivePituitary adenomas (PA) are among the most common human neoplasms. To describe the epidemiology and assess the disease burden of clinically significant PAs, population-based studies are needed. Iceland has a small well-defined population. The aim of this study is to describe the epidemiology of PAs in Iceland over an expanded period of time.DesignThis is a retrospective observational study, including all PAs diagnosed in Iceland from 1955 to 2012.MethodsExtensive clinical information was gathered in a database. Prevalence rates for all PA subtypes were calculated along with standardized incidence rates (SIR). Sex ratios and relationships with adenoma size, age, and symptoms were assessed.ResultsWe identified 471 individuals: 190 men and 281 women. Total prevalence in 2012 was 115.57/100 000, prolactinomas were most prevalent (54.37/100 000) followed by non-functioning adenomas (NFPAs) (42.32/100 000). Throughout the period, NFPAs were most common (43.0%) followed by prolactinomas (39.9%) and 11.3% had acromegaly and 5.7% Cushing's disease. Women are diagnosed younger with smaller adenomas. Total SIR has increased significantly and is now 5.8/100 000 per year.ConclusionIn this nationwide study spanning six decades, we have confirmed PAs rising prevalence and incidence rates noted in recent studies. We demonstrated higher overall prevalence and incidence rates than ever previously recorded with an increasing predominance of NFPAs, which is not explained by incidental findings alone. There is a relationship with the introduction of imaging modalities, but the vast majority of patients are symptomatic at diagnosis. This underlines the importance of increased awareness, education, and appropriate allocation of resources for this growing group of patients.


2017 ◽  
Vol 45 (4) ◽  
pp. 574-579 ◽  
Author(s):  
Mohanad M. Elfishawi ◽  
Nour Zleik ◽  
Zoran Kvrgic ◽  
Clement J. Michet ◽  
Cynthia S. Crowson ◽  
...  

Objective.To examine the incidence of gout over the last 20 years and to evaluate possible changes in associated comorbid conditions.Methods.The medical records were reviewed of all adults with a diagnosis of incident gout in Olmsted County, Minnesota, USA, during 2 time periods (January 1, 1989–December 31, 1992, and January 1, 2009–December 31, 2010). Incident cases had to fulfill at least 1 of 3 criteria: the American Rheumatism Association 1977 preliminary criteria for gout, the Rome criteria, or the New York criteria.Results.A total of 158 patients with new-onset gout were identified during 1989–1992 and 271 patients during 2009–2010, yielding age- and sex-adjusted incidence rates of 66.6/100,000 (95% CI 55.9–77.4) in 1989–1992 and 136.7/100,000 (95% CI 120.4–153.1) in 2009–2010. The incidence rate ratio was 2.62 (95% CI 1.80–3.83). At the time of their first gout flare, patients diagnosed with gout in 2009–2010 had higher prevalence of comorbid conditions compared with 1989–1992, including hypertension (69% vs 54%), diabetes mellitus (25% vs 6%), renal disease (28% vs 11%), hyperlipidemia (61% vs 21%), and morbid obesity (body mass index ≥ 35 kg/m2; 29% vs 10%).Conclusion.The incidence of gout has more than doubled over the recent 20 years. This increase together with the more frequent occurrence of comorbid conditions and cardiovascular risk factors represents a significant public health challenge.


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