scholarly journals Risk factors for baclofen pump infection in children: a multivariate analysis

2016 ◽  
Vol 17 (6) ◽  
pp. 756-762 ◽  
Author(s):  
Heather S. Spader ◽  
Robert J. Bollo ◽  
Christian A. Bowers ◽  
Jay Riva-Cambrin
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Potential Risk ◽  
Univariate Analysis ◽  
Wound Dehiscence ◽  
Young Age ◽  
Csf Leak ◽  
Pump Placement ◽  
Potential Risk Factors ◽  
Independent Risk Factors

OBJECTIVE Intrathecal baclofen infusion systems to manage severe spasticity and dystonia are associated with higher infection rates in children than in adults. Factors unique to this population, such as poor nutrition and physical limitations for pump placement, have been hypothesized as the reasons for this disparity. The authors assessed potential risk factors for infection in a multivariate analysis. METHODS Patients who underwent implantation of a programmable pump and intrathecal catheter for baclofen infusion at a single center between January 1, 2000, and March 1, 2012, were identified in this retrospective cohort study. The primary end point was infection. Potential risk factors investigated included preoperative (i.e., demographics, body mass index [BMI], gastrostomy tube, tracheostomy, previous spinal fusion), intraoperative (i.e., surgeon, antibiotics, pump size, catheter location), and postoperative (i.e., wound dehiscence, CSF leak, and number of revisions) factors. Univariate analysis was performed, and a multivariate logistic regression model was created to identify independent risk factors for infection. RESULTS A total of 254 patients were evaluated. The overall infection rate was 9.8%. Univariate analysis identified young age, shorter height, lower weight, dehiscence, CSF leak, and number of revisions within 6 months of pump placement as significantly associated with infection. Multivariate analysis identified young age, dehiscence, and number of revisions as independent risk factors for infection. CONCLUSIONS Young age, wound dehiscence, and number of revisions were independent risk factors for infection in this pediatric cohort. A low BMI and the presence of either a gastrostomy or tracheostomy were not associated with infection and may not be contraindications for this procedure.

scholarly journals C-reactive protein predicts complications in community-associated S. aureus bacteraemia: a cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Carly L. Botheras ◽  
Steven J. Bowe ◽  
Raquel Cowan ◽  
Eugene Athan
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Potential Risk ◽  
Univariate Analysis ◽  
Foot Ulcer ◽  
Entry Point ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Potential Risk Factors ◽  
Portal Of Entry

Abstract Background Staphylococcus aureus (S. aureus) bacteraemia is increasingly acquired from community settings and is associated with a mortality rate of up to 40% following complications. Identifying risk factors for complicated S. aureus bacteraemia would aid clinicians in targeting patients that benefit from expedited investigations and escalated care. Methods In this prospective observational cohort study, we aimed to identify risk factors associated with a complicated infection in community-onset S. aureus bacteraemia. Potential risk factors were collected from electronic medical records and included: - patient demographics, symptomology, portal of entry, and laboratory results. Results We identified several potential risk factors using univariate analysis. In a multiple logistic regression model, age, haemodialysis, and entry point from a diabetic foot ulcer were all significantly protective against complications. Conversely, an unknown entry point of infection, an entry point from an indwelling medical device, and a C-reactive protein concentration of over 161 mg/L on the day of admission were all significantly associated with complications. Conclusions We conclude that several factors are associated with complications including already conducted laboratory investigations and portal of entry of infection. These factors could aid the triage of at-risk patients for complications of S. aureus bacteraemia.

scholarly journals Risk Factors for Severe 30-d Complications After Minimally Invasive Radical Cystectomy With Ileal Conduit

2020 ◽  
Author(s):  
Ming Xiao ◽  
Zhaohui Zhong ◽  
Jiannan Ren ◽  
Wei Xiong
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Radical Cystectomy ◽  
Ileal Conduit ◽  
Univariate Analysis ◽  
Comprehensive Complication Index ◽  
Estimated Blood Loss ◽  
Independent Risk Factors

Abstract Background: To investigate the risk factors for severe complications within 30 days in patients receiving minimally invasive radical cystectomy with ileal conduit(MIRCIC).Methods: 270 consecutive patients who underwent MIRCIC between January 1, 2013 and August 1, 2020 were included. All complications were graded according to the Clavien-Dindo classification(CDC). The comprehensive complication index(CCI) for all complications in each patient was calculated. CDC ≥ Ⅲ or CCI > 33.7 were considered to be severe complications. Univariate and multivariate analysis were conducted by SPSS26.Results: A total of 691 complications were collected from 236 patients and the corresponding overall complications rate was 87.41% (236/270). Patients with CDC ≥ Ⅲ accounted for 23.70% and the incidence of CCI > 33.7 was 22.96%. For the highest CDC grade ≥ Ⅲ, in univariate analysis, the following seven variants were enrolled in a multivariate analysis: BMI (P=0.010), baseline albumin(P=0.065), pT (P=0.082), pN (P=0.026), pTNM (P=0.016), intraoperative blood transfusion (P=0.031), estimated blood loss (P=0.001). In multivariate analysis, BMI ≥ 30kg/m2 (P=0.012) and estimated blood loss ≥ 400ml (P=0.005) were the independent risk factors of CDC ≥ Ⅲ. Hydronephrosis (P=0.050), BMI (P=0.006), pT (P=0.004), pN (P=0.019), pTNM (P=0.000), operative time (P=0.030), estimated blood loss (P=0.001) were the relevant factors in CCI > 33.7. However, BMI ≥ 30kg/m2 (P=0.004) and estimated blood loss (P=0.002) were the independent risk factors of CCI > 33.7.Conclusion: BMI ≥ 30kg/m2 and estimated blood loss ≥ 400ml were found to be independent predictors of 30-d severe complications (CDC ≥ Ⅲ or CCI > 33.7) in patients who underwent MIRCIC.

Immunized Against Hepatitis B Virus Allografted Recipients Are at High Risk for Gradual Surface Antibody (HbsAb) Disappearance Post Transplant, Regardless of Adoptive Immunity Transfer: A Study of 82 Allografted Long Term Survivors.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2862-2862
Author(s):  
Panayotis Kaloyannidis ◽  
Evangelia Yannaki ◽  
Ioannis Batsis ◽  
Despoina Adamidou ◽  
Demetrios Bartzoudis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Hepatitis B Virus ◽  
Hepatitis B ◽  
Potential Risk ◽  
Post Transplant ◽  
B Virus ◽  
Potential Risk Factors ◽  
Adoptive Immunity ◽  
Surface Antibody

Abstract The presence of Hepatitis-B virus(HBV) surface antibody(HbsAb) is a strong indicator for the existence of HBV-immunity. Immunosuppressed allografted recipients are at risk of developing HBV hepatitis due to the potential loss of their immunity against HBV. The primary aim of the present study was to evaluate the incidence of HbsAb eradication post allo-transplantation, the potential risk factors and the impact of adoptive immunity transfer in the HbsAb loss. Additionally, to estimate the cumulative incidence of HBV infection in patients (pts) with HbsAb disappearance. Eighty-two immunized recipients aged 27(14–54) years and their donors were retrospectively studied. Fifty-six pts were naturally immunized while 26 were vaccinated. The median follow-up period was 36(6–132) months. Seventy-two were transplanted from siblings (4 with 1 Ag mismatch). Seven donors were matched unrelated volunteers, 2 were twins and 1 was haploidentical. Eighty-one pts received myeloablative conditioning. Marrow (BM) was infused in 23 pts, peripheral stem cells (PBSC) in 58 and BM plus PBSC in 1, with a median number of CD34:4,45x106/Kg, CD3:2,77x108/Kg, CD4:1,16x108/Kg, CD8: 1,06x108/Kg. Antithymocyte globulin (ATG) was administered to 15 and steroids to 54 pts. Thirty pts developed acute and 71 chronic graft versus host disease (cGVHD). Forty-six donors were non-immunized, 19 vaccinated and 13 naturally immunized. Data on immunity origin were missing for 4 donors. HbsAb disappearance was observed in 39/82 pts, 24(6–60) months post transplant with a probability of loss 90% at 5 years. Multivariate analysis revealed as significant risk factors for HbsAb loss the BM graft, ATG administration, age (<30years) and cGvHD development. The type of donor’s immunization had no significant impact, although the probability of losing HBV-immunity was 100%, 78%, and 58% for pts transplanted from nonimmunized, vaccinated and naturally immunized donors, respectively. As the adoptive transfer of HBV immunity is a well-documented phenomenon, we studied separately, in the 36 allografted pts from immunized donors, the potential risk factors for HbsAb loss. Multivariate analysis identified as risk factors for this loss, the use of ATG, BM graft, and donor’s vaccination. The use of steroids had a strong tendency towards significance(p:0,06). Among the 39 pts who lost immunity, 6 developed hepatitisB. All had a previous natural immunity. Four had been transplanted from non-immunized and 2 from naturally immunized donors and all had been treated or were on intensive therapy for refractory cGvHD. The probability for HBV infection for pts who lost the HbsAb, regardless of immunity origin, was 18% at 12 years. Six of 28 naturally immunized pts who lost the HbsAb developed hepatitis. In this cohort of pts the probability of HBV reactivation was estimated to be 26% at 12 years. In our study, the majority of pts lost their pre-transplant protection against HBV while the adoptive transfer of immunity, although established, didn’t offer long-lasting protection. As the possibility of hepatitisB is not negligible, serial serological monitoring and timely vaccination schedule for re-immunization in the early but also in the late post transplant period, might be necessary for patients with low or decreasing HbsAb titers.

scholarly journals 2013. Blood Culture Contamination in the Emergency Department: A Risk Factor Analysis

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S675-S676
Author(s):  
Justin Klucher ◽  
Mrinmayee Lakkad ◽  
Jacob Painter ◽  
Ryan K Dare
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Factor Analysis ◽  
Risk Factor ◽  
High Risk ◽  
Potential Risk ◽  
False Positive ◽  
Univariate Analysis ◽  
Sterile Technique ◽  
Potential Risk Factors

Abstract Background Blood cultures (BCx) guide treatment for hospitalized patients, yet contaminated BCx lead to clinical uncertainty, impacting care. The Clinical and Laboratory Standards Institute (CLSI) recommends contamination rates should be <3%, yet our Emergency Department (ED) rate is consistently above this benchmark. Reasons for this are unclear, thus it is imperative to investigate potential risk factors for BCx contamination. Methods We performed a retrospective case–control risk factor analysis of patients with BCx collected in our ED between 2014 and 2018. Contaminated BCx were identified by the microbiology laboratory per American Society of Microbiology recommendations. Demographics, comorbidities, and clinical characteristics were evaluated in patients with false-positive/contaminated BCx (cases) and patients with negative BCx (controls). Potential risk factors identified in univariate analysis were included in a logistic regression model. Unadjusted and adjusted analyses were performed using SAS 9.4. Results 25,668 BCx from 13,782 patients were included in analysis. 20,907 BCx from 11,266 (82%) patients were negative, 2,856 BCx from 1,504 (11%) patients were true positives, and 1,905 BCx from 1,012 (7%) patients were contaminated. Yearly ED contamination rates ranged from 5.0–9.3%. Collector contamination rates varied, though 38 (19%), 75 (35%), and 7 (3%) of 209 collectors had a contamination rate <3%, ≥ 10%, and ≥ 20%, respectively. Significant patient-specific risk factors identified in univariate analysis are listed in the attached table along with adjusted analysis. Conclusion In our analysis, we identified that older age, African American race, higher BMI, COPD, paralysis, and presenting in septic shock independently increases risk of having a contaminated BCx. Difficulty obtaining venipuncture in patients with these risk factors, often requiring multiple collection attempts, likely leads to decreased sterile technique. It is imperative to have a process assuring sterile technique in these high-risk individuals to minimize consequences associated with having a false-positive BCx result in these high-risk patients. Additionally, variable collector contamination rates seen in this study highlight the necessity for frequent technique in-service training. Disclosures All authors: No reported disclosures.

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