Adverse outcomes of colonisation with vancomycin-resistant enterococci: a retrospective cohort study, Norway, 2010–2015

Abstract Background Vancomycin is now a preferred treatment for all cases of Clostridioides difficile infection (CDI), regardless of disease severity. Concerns remain that a large-scale shift to oral vancomycin may increase selection pressure for vancomycin-resistant Enterococci (VRE). We evaluated the risk of VRE following oral vancomycin or metronidazole treatment among patients with CDI. Methods We conducted a retrospective cohort study of patients with CDI in the US Department of Veterans Affairs health system between 1 January 2006 and 31 December 2016. Patients were included if they were treated with metronidazole or oral vancomycin and had no history of VRE in the previous year. Missing data were handled by multiple imputation of 50 datasets. Patients treated with oral vancomycin were compared to those treated with metronidazole after balancing on patient characteristics using propensity score matching in each imputed dataset. Patients were followed for VRE isolated from a clinical culture within 3 months. Results Patients treated with oral vancomycin were no more likely to develop VRE within 3 months than metronidazole-treated patients (adjusted relative risk, 0.96; 95% confidence interval [CI], .77 to 1.20), equating to an absolute risk difference of −0.11% (95% CI, −.68% to .47%). Similar results were observed at 6 months. Conclusions Our results suggest that oral vancomycin and metronidazole are equally likely to impact patients’ risk of VRE. In the setting of stable CDI incidence, replacement of metronidazole with oral vancomycin is unlikely to be a significant driver of increased risk of VRE at the patient level. In this multicenter, retrospective cohort study of patients with Clostridioides difficile infection, the use of oral vancomycin did not increase the risk of vancomycin-resistant Enterococci infection at 3 or 6 months compared to metronidazole.

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321 Is Serum Bicarbonate Level Associated With Adverse Outcomes in Paediatric Patients?: A Retrospective Cohort Study

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2015.07.357 ◽

2015 ◽

Vol 66 (4) ◽

pp. S116

Author(s):

D.G. Mainprize ◽

N. Poonai ◽

C. Travers ◽

L. Wong ◽

T. Tryphonopoulos ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Adverse Outcomes ◽

Bicarbonate Level ◽

Serum Bicarbonate ◽

Paediatric Patients ◽

Serum Bicarbonate Level

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Iron deficiency in 78 805 people admitted with heart failure across England: a retrospective cohort study

Open Heart ◽

10.1136/openhrt-2019-001153 ◽

2020 ◽

Vol 7 (1) ◽

pp. e001153 ◽

Cited By ~ 2

Author(s):

James M Beattie ◽

Rani Khatib ◽

Ceri J Phillips ◽

Simon G Williams

Keyword(s):

Heart Failure ◽

Cohort Study ◽

Iron Deficiency ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Primary Diagnosis ◽

Adverse Outcomes ◽

Health Economy ◽

Inpatient Mortality ◽

Readmission Rates

ObjectivesIron deficiency (ID), with or without anaemia (IDA), is an important comorbidity in people with chronic heart failure (HF), but the prevalence and significance in those admitted with HF is uncertain. We assessed the prevalence of ID or IDA in adults (age ≥21 years) hospitalised with a primary diagnosis of HF, and examined key metrics associated with these secondary diagnoses.MethodsA retrospective cohort study of Hospital Episode Statistics describing all adults admitted to National Health Service (NHS) hospitals across England from April 2015 through March 2016 with primary diagnostic discharge coding as HF, with or without subsidiary coding for ID/IDA.Results78 805 adults were admitted to 177 NHS hospitals with primary coding as HF: 26 530 (33.7%) with secondary coding for ID/IDA, and 52 275 (66.3%) without. Proportionately more patients coded ID/IDA were admitted as emergencies (94.8% vs 87.6%; p<0.0001). Tending to be older and female, they required a longer length of stay (15.8 vs 12.2 days; p<0.0001), with higher per capita costs (£3623 vs £2918; p<0.0001), the cumulative excess expenditure being £21.5 million. HF-related (8.2% vs 5.2%; p<0.0001) and all-cause readmission rates (25.8% vs 17.7%; p<0.05) at ≤30 days were greater in those with ID/IDA against those without, and they manifested a small but statistically significant increased inpatient mortality (13.5% v 12.9%; p=0.009).ConclusionsFor adults admitted to hospitals in England, principally with acute HF, ID/IDA are significant comorbidities and associated with adverse outcomes, both for affected individuals, and the health economy.

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Predictors of adverse outcomes in COVID-19: A retrospective cohort study comparing the first two waves of COVID-19 hospital admissions in London, with a focus on diabetes

Endocrine Abstracts ◽

10.1530/endoabs.77.p186 ◽

2021 ◽

Author(s):

Durreshahwar Hashmi ◽

Yusuf Shaikhali ◽

Rebecca Cassin-Scott ◽

Pei Eng ◽

Walter Distaso ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Hospital Admissions ◽

Adverse Outcomes

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Trauma and Pregnancy: Is Flow Cytometry Detection and Quantification of Fetal Red Blood Cells Useful? A Retrospective Cohort Study.

10.21203/rs.3.rs-166660/v1 ◽

2021 ◽

Author(s):

Misgav Rottenstreich ◽

Reut Meir ◽

Itamar Glick ◽

Heli Alexandrony ◽

Alon D Schwarz ◽

...

Keyword(s):

Flow Cytometry ◽

Cohort Study ◽

Red Blood Cells ◽

Pregnant Women ◽

Retrospective Cohort Study ◽

Blood Cells ◽

Retrospective Cohort ◽

Neonatal Outcome ◽

Adverse Outcomes ◽

Minor Trauma

Abstract Purpose: To assess whether positive flow cytometry quantification of fetal red blood cells is associated with adverse outcomes in cases of trauma during pregnancy.Methods: A retrospective cohort study, at a single tertiary center between 2013 and 2019. All pregnant women with viable gestation involved in trauma who underwent flow cytometry were included. Flow cytometry was considered positive (≥0.03/≥30 ml). Composite adverse maternal and neonatal outcomes were compared between cases with positive and negative flow cytometry test. Univariate and multivariate logistic regression analysis were performed to assess the role of flow cytometry in predicting adverse outcomes. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated.Results: During the study 1023 women met inclusion and exclusion criteria. The mechanisms of injury were motor vehicle accident in 387 women (38%), falls in 367 (36%), direct abdominal trauma in 353 (35%) and in 14 women (1%) other mechanism of injury. Among the cohort, 119 women (11.6%) had positive flow cytometry (≥0.03/≥30 ml) with median result of 0.03 [0.03-0.04], while 904 women (88.4%) had negative flow cytometry test result (≤0.03/≤30 ml) with median result of 0.01 [0.01-0.02]. Composite adverse outcome occurred in 8% of the women, with no difference in the groups with vs. without positive flow cytometry (4.2% vs. 8.5%; p=0.1). Positive flow cytometry was not associated with any adverse maternal or neonatal outcome. This was confirmed on a multivariate analysis. Conclusions: Flow cytometry result is not related to adverse maternal and fetal/neonatal outcome of women involved in minor trauma during pregnancy. We suggest that flow cytometry should not be routinely assessed in pregnant women involved in minor trauma.

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A retrospective cohort study of antibiotic exposure and vancomycin-resistant Enterococcus recolonization

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.15 ◽

2019 ◽

Vol 40 (4) ◽

pp. 414-419

Author(s):

Heather Y. Hughes ◽

Robin T. Odom ◽

Angela V. Michelin ◽

Evan S. Snitkin ◽

Ninet Sinaii ◽

...

Keyword(s):

Cohort Study ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Positive Culture ◽

National Institutes Of Health ◽

Antibiotic Exposure ◽

Contact Isolation ◽

Clinical Center ◽

Vancomycin Resistant ◽

Hospital Days

AbstractObjective:In the National Institutes of Health (NIH) Clinical Center, patients colonized or infected with vancomycin-resistant Enterococcus (VRE) are placed in contact isolation until they are deemed “decolonized,” defined as having 3 consecutive perirectal swabs negative for VRE. Some decolonized patients later develop recurrent growth of VRE from surveillance or clinical cultures (ie, “recolonized”), although that finding may represent recrudescence or new acquisition of VRE. We describe the dynamics of VRE colonization and infection and their relationship to receipt of antibiotics.Methods:In this retrospective cohort study of patients at the National Institutes of Health Clinical Center, baseline characteristics were collected via chart review. Antibiotic exposure and hospital days were calculated as proportions of VRE decolonized days. Using survival analysis, we assessed the relationship between antibiotic exposure and time to VRE recolonization in a subcohort analysis of 72 decolonized patients.Results:In total, 350 patients were either colonized or infected with VRE. Among polymerase chain reaction (PCR)-positive, culture (Cx)-negative (PCR+/Cx−) patients, PCR had a 39% positive predictive value for colonization. Colonization with VRE was significantly associated with VRE infection. Among 72 patients who met decolonization criteria, 21 (29%) subsequently became recolonized. VRE recolonization was 4.3 (P = .001) and 2.0 (P = .22) times higher in patients with proportions of antibiotic days and antianaerobic antibiotic days above the median, respectively.Conclusion:Colonization is associated with clinical VRE infection and increased mortality. Despite negative perirectal cultures, re-exposure to antibiotics increases the risk of VRE recolonization.

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