A HOSPITAL-BASED STUDY ON RISK FACTORS OF RECURRENT CLOSTRIDIUM DIFFICILE ASSOCIATED DISEASE IN HONG KONG

IntroductionDementia is a group of disabling disorders that can be devastating for persons living with it and for their families. Data-informed decision-making strategies to identify individuals at high risk of dementia are essential to facilitate large-scale prevention and early intervention. This population-based case–control study aims to develop and validate a clinical algorithm for predicting dementia diagnosis, based on the cognitive footprint in personal and medical history.Methods and analysisWe will use territory-wide electronic health records from the Clinical Data Analysis and Reporting System (CDARS) in Hong Kong between 1 January 2001 and 31 December 2018. All individuals who were at least 65 years old by the end of 2018 will be identified from CDARS. A random sample of control individuals who did not receive any diagnosis of dementia will be matched with those who did receive such a diagnosis by age, gender and index date with 1:1 ratio. Exposure to potential protective/risk factors will be included in both conventional logistic regression and machine-learning models. Established risk factors of interest will include diabetes mellitus, midlife hypertension, midlife obesity, depression, head injuries and low education. Exploratory risk factors will include vascular disease, infectious disease and medication. The prediction accuracy of several state-of-the-art machine-learning algorithms will be compared.Ethics and disseminationThis study was approved by Institutional Review Board of The University of Hong Kong/Hospital Authority Hong Kong West Cluster (UW 18-225). Patients’ records are anonymised to protect privacy. Study results will be disseminated through peer-reviewed publications. Codes of the resulted dementia risk prediction algorithm will be made publicly available at the website of the Tools to Inform Policy: Chinese Communities’ Action in Response to Dementia project (https://www.tip-card.hku.hk/).

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The Epidemiology of Household Rodenticides Poisoning in Hong Kong and its Risk Factors for Developing Coagulopathy

Hong Kong Journal of Emergency Medicine ◽

10.1177/102490791402100601 ◽

2014 ◽

Vol 21 (6) ◽

pp. 339-345 ◽

Cited By ~ 1

Author(s):

N Othman ◽

Ck Chan ◽

Fl Lau

Keyword(s):

Risk Factors ◽

Hong Kong ◽

Emergency Departments ◽

Multiple Logistic Regression Analysis ◽

Case Series ◽

Female Ratio ◽

Intentional Ingestion ◽

Accident And Emergency ◽

Case Series Study ◽

Clinically Significant

Objective To (1) describe the epidemiology of household rodenticides poisoning in Hong Kong, (2) evaluate the proportion of patients who have develop coagulopathy after rodenticide poisoning, (3) identify the risk factors for developing coagulopathy in rodenticide poisoning. Design Case series study. Setting Sixteen accident and emergency departments in Hong Kong. Patients Patients with household rodenticide ingestion who presented to accident and emergency departments during the period from July 2008 to February 2012. Results 110 patients were reported to have rodenticide exposure during the study period. Eighty-seven patients were included in the final analysis. The mean age was 40.1 and the male-to-female ratio was 1.29:1 (49:38). Most patients (91%) took the rodenticide intentionally. Sixty-nine patients (79%) exposed to anticoagulants type of rodenticide based on history or laboratory findings. The ingredient of the rodenticide ingested in 18 patients (21%) was untraceable. The only clinically significant presentation reported after rodenticide exposure was coagulopathy. Thirty-one patients (36%) developed coagulopathy with an international normalised ratio greater or equal to 1.3. Clinical significant bleeding was only observed in one patient. Presence of coagulopathy in rodenticide poisoning was significantly associated with older patient, intentional ingestion, ingestion of warfarin, ingestion of more than one pack and presence of co-ingestion. Multiple logistic regression analysis showed that only two factors were independent predictor of coagulopathy: Ingestion of warfarin rodenticide (p=0.001, odds ratio [OR] = 18.20, 95% confidence interval [CI]=3.44-96.42), and ingestion of more than one pack of rodenticide (p=0.02, OR=10.01, 95% CI=1.43-69.87). Conclusions Clinically significant household rodenticide poisoning in Hong Kong is solely related to ingestion of anticoagulant type of rodenticide. Patients who have ingested warfarin rodenticide and higher ingestion dose are more likely in developing coagulopathy. (Hong Kong j.emerg.med. 2014;21:339-345)

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Risk Factors and Outcomes Associated With Severe Clostridium difficile Infection in Children

The Pediatric Infectious Disease Journal ◽

10.1097/inf.0b013e3182352e2c ◽

2012 ◽

Vol 31 (2) ◽

pp. 134-138 ◽

Cited By ~ 85

Author(s):

Jason Kim ◽

Julia F. Shaklee ◽

Sarah Smathers ◽

Priya Prasad ◽

Lindsey Asti ◽

...

Keyword(s):

Risk Factors ◽

Clostridium Difficile ◽

Clostridium Difficile Infection ◽

Severe Clostridium Difficile Infection

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Risk Factors for Recurrence of Clostridium Difficile-associated Diarrhea in the Elderly

Scandinavian Journal of Infectious Diseases ◽

10.1080/00365540210147525 ◽

2002 ◽

Vol 34 (8) ◽

pp. 594-597 ◽

Cited By ~ 29

Author(s):

Sari Tal ◽

Alexander Gurevich ◽

Vladimir Guller ◽

Irina Gurevich ◽

David Berger ◽

...

Keyword(s):

Risk Factors ◽

Clostridium Difficile ◽

The Elderly ◽

Risk Factors For Recurrence ◽

Clostridium Difficile Associated Diarrhea

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A Comprehensive Assessment Across the Healthcare Continuum: Risk of Hospital-Associated Clostridium difficile Infection Due to Outpatient and Inpatient Antibiotic Exposure

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.220 ◽

2015 ◽

Vol 36 (12) ◽

pp. 1409-1416 ◽

Cited By ~ 23

Author(s):

Sara Y. Tartof ◽

Gunter K. Rieg ◽

Rong Wei ◽

Hung Fu Tseng ◽

Steven J. Jacobsen ◽

...

Keyword(s):

Risk Factors ◽

Clostridium Difficile ◽

Southern California ◽

Skilled Nursing Facility ◽

Antibiotic Exposure ◽

Kaiser Permanente ◽

Nursing Facility ◽

Skilled Nursing ◽

Transfer Factors ◽

Adjusted Risk

BACKGROUNDLimitations in sample size, overly inclusive antibiotic classes, lack of adjustment of key risk variables, and inadequate assessment of cases contribute to widely ranging estimates of risk factors for Clostridium difficile infection (CDI).OBJECTIVETo incorporate all key CDI risk factors in addition to 27 antibiotic classes into a single comprehensive model.DESIGNRetrospective cohort study.SETTINGKaiser Permanente Southern California.PATIENTSMembers of Kaiser Permanente Southern California at least 18 years old admitted to any of its 14 hospitals from January 1, 2011, through December 31, 2012.METHODSHospital-acquired CDI cases were identified by polymerase chain reaction assay. Exposure to major outpatient antibiotics (10 classes) and those administered during inpatient stays (27 classes) was assessed. Age, sex, self-identified race/ethnicity, Charlson Comorbidity Score, previous hospitalization, transfer from a skilled nursing facility, number of different antibiotic classes, statin use, and proton pump inhibitor use were also assessed. Poisson regression estimated adjusted risk of CDI.RESULTSA total of 401,234 patients with 2,638 cases of incident CDI (0.7%) were detected. The final model demonstrated highest CDI risk associated with increasing age, exposure to multiple antibiotic classes, and skilled nursing facility transfer. Factors conferring the most reduced CDI risk were inpatient exposure to tetracyclines and first-generation cephalosporins, and outpatient macrolides.CONCLUSIONSAlthough type and aggregate antibiotic exposure are important, the factors that increase the likelihood of environmental spore acquisition should not be underestimated. Operationally, our findings have implications for antibiotic stewardship efforts and can inform empirical and culture-driven treatment approaches.Infect. Control Hosp. Epidemiol. 2015;36(12):1409–1416

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