scholarly journals Analysis of Risk Factors for Carbapenem-Resistant Klebsiella pneumoniae Infection and Its Effect on the Outcome of Early Infection After Kidney Transplantation

2021 ◽  
Vol 11 ◽  
Author(s):  
Fei Zhang ◽  
Jinbiao Zhong ◽  
Handong Ding ◽  
Jiashan Pan ◽  
Jing Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Survival Rate ◽  
Klebsiella Pneumoniae ◽  
Postoperative Mortality ◽  
Effective Prevention ◽  
Carbapenem Resistant ◽  
Kaplan Meier ◽  
Total Prevalence ◽  
One Year ◽  
The One

BackgroundInfections remain a major cause of morbidity and mortality in kidney transplant (KT) recipients. This study was performed to identify the overall prevalence of early infections, prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection after KT, one-year postoperative mortality in patients with early infections and risk factors for CRKP infections.MethodsWe conducted a retrospective study of all patients who received KT in our hospital between January 2017 and December 2019. We evaluated the demographic, clinical, infection characteristics and the one-year postoperative outcomes.ResultsAmong the 419 patients who received KT between January 2017 and December 2019, 150 patients had at least one infection within 90 days after KT. The total prevalence of early infections was 36.1% (150/415), the prevalence of early CRKP infections was 10.4% (43/415), and the one-year postoperative mortality was 15.3% (23/150) in patients with early infections. The risk factors independently related to one-year postoperative mortality were mechanical ventilation (MV) > 48 h (Odds ratio (OR)= 13.879, 95%Confidence interval (CI): 2.265~85.035; P=0.004) and CRKP infection (OR=6.751, 95% CI: 1.051~43.369; P =0.044). MV> 48 h was independently related to CRKP infection (OR=3.719, 95% CI: 1.024~13.504; P=0.046). Kaplan-Meier survival curves showed that the one-year survival rate of patients infected with CRKP in the early postoperative stage was significantly lower than that of uninfected patients.ConclusionsIn general, the prevalence of early infections after KT is high, and CRKP infection is closely correlated with poor prognosis. The effective prevention and treatment of CRKP infection is an important way to improve the one-year survival rate after KT.

THE ROLE OF TRANSARTERIAL CHEMOEMBOLIZATION IN THE TREATMENT OF HEPATOCELLULAR CARCINOMA IN THE STAGE B OF BCLC

2019 ◽  
pp. 37-42
Author(s):  
Talgat Tajibaev ◽  
Bolatbek Baimakhanov ◽  
Ulugbek Medeubekov ◽  
Shokan Kaniev ◽  
Bekzhan Issamatov
Keyword(s):  
Hepatocellular Carcinoma ◽  
Survival Rate ◽  
Transarterial Chemoembolization ◽  
Survival Curve ◽  
Intermediate Stage ◽  
Kaplan Meier ◽  
Contrast Enhanced Ct ◽  
Number Of Patients ◽  
One Year ◽  
The One

Hepatocellular carcinoma is the most common primary tumor pathology of the liver (> 85%), an aggressive course with an unfavorable prognosis. Objective: To analyze the results of transarterial chemoembolization in the intermediate stage of hepatocellular carcinoma. Materials and methods: The study was conducted on the basis of the JSC “National Scientific Center of Surgery” named after A.N. Syzganov in the period 2013-2018. Statistical calculations were performed using Excel, SPSS Statistics by estimating the survival rate using the Kaplan-Meier method. Results: The study included 58 patients with HCC in the B stage of BCLC. The average age of the patients was 60.4 years. The follow-up period was 6–64 months. In 42 patients, the test results for viral hepatitis were positive. 58 patients underwent 103 TACE interventions. After chemoembolization, 8 patients subsequently underwent surgery (liver resection). The one-year survival after TACE in the total cohort was 42%, 2-year - 15% and 3-year - 5%, respectively. In patients older than 60 and 70 years, the 3-year and 5-year survival rates were 0%, the one-year survival rate of the subjects studied in the group over 70 years old was 14.3%. The survival rate among patients in stage B on the Chile-Pugh scale was significantly lower to patients in stage A (82% versus 56% for 6 months and 50% versus 31% for the year, respectively). Statistically significant differences were found in the group with a substantial increase in AFP (> 1000 IU / ml), the Kaplan-Meier survival curve showed a survival rate of 0% after 18 months since the first TACE. Six months after TACE contrast enhanced CT was performed on 36 patients, of which 15 patients showed positive dynamics, in the form of a reduction in size or transformation of the formation, in 6 patients a negative dynamics in the form of an increase in the size of the formation. Conclusion: Despite the small number of patients studied, TACE showed good results in the intermediate stage of HCC. Elderly and senile age, a high degree of liver dysfunction, as well as high AFP values are additional factors that dramatically reduce the life expectancy of patients after TACE with HCC in stage B-BCLC.

Disease Severity Is an Independent Risk Factor of Mortality and Outcomes in Critically Ill Patients With Carbapenem-resistant Klebsiella Pneumoniae Bloodstream Infections: a 5-year Retrospective Analysis

2021 ◽  
Author(s):  
Yuzhen Qiu ◽  
Wen Xu ◽  
Yunqi Dai ◽  
Ruoming Tan ◽  
Jialin Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Klebsiella Pneumoniae ◽  
Critically Ill Patients ◽  
Bloodstream Infections ◽  
Polymyxin B ◽  
Mortality Rates ◽  
Carbapenem Resistant ◽  
All Cause Mortality ◽  
Independent Risk Factors

Abstract Background: Carbapenem-resistant Klebsiella pneumoniae bloodstream infections (CRKP-BSIs) are associated with high morbidity and mortality rates, especially in critically ill patients. Comprehensive mortality risk analyses and therapeutic assessment in real-world practice are beneficial to guide individual treatment.Methods: We retrospectively analyzed 87 patients with CRKP-BSIs (between July 2016 and June 2020) to identify the independent risk factors for 28-day all-cause mortality. The therapeutic efficacies of tigecycline-and polymyxin B-based therapies were analyzed.Results: The 28-day all-cause mortality and in-hospital mortality rates were 52.87% and 67.82%, respectively, arising predominantly from intra-abdominal (56.32%) and respiratory tract infections (21.84%). A multivariate analysis showed that 28-day all-cause mortality was independently associated with the patient’s APACHE II score (p = 0.002) and presence of septic shock at BSI onset (p = 0.006). All-cause mortality was not significantly different between patients receiving tigecycline- or polymyxin B-based therapy (55.81% vs. 53.85%, p = 0.873), and between subgroups mortality rates were also similar. Conclusions: Critical illness indicators (APACHE II scores and presence of septic shock at BSI onset) were independent risk factors for 28-day all-cause mortality. There was no significant difference between tigecycline- and polymyxin B-based therapy outcomes. Prompt and appropriate infection control should be implemented to prevent CRKP infections.

scholarly journals An analytical study of prevalence of ear disorders and their risk factors among children in a resettlement colony of Delhi

2021 ◽  
Vol 8 (3) ◽  
pp. 13-19
Author(s):  
Gupta Kalika ◽  
Gourav Kumar Goyal ◽  
Akshay Berad
Keyword(s):  
Risk Factors ◽  
Hearing Loss ◽  
Educational Status ◽  
School Age Children ◽  
Cross Sectional ◽  
Total Prevalence ◽  
Study Results ◽  
Group 5 ◽  
One Year ◽  
Associated Risk Factors

Background: The world has more than 360 million population (almost 5% of world’s population) with disabling hearing loss and among them, 32 million are children. It is estimated that over 166 million people in the developing world face a severe lack of intervention services for hearing loss. There is a need to estimate the magnitude of various ear morbidities in school age children as well as to identify the various risk factors that play a role in the emergence of these morbidities. Aim: To find prevalence of various ear disorders and their risk factors among children 5-11 years old. Methodology: It was a cross-sectional, community based study conducted at a resettlement colony named Gokulpuri, in East Delhi. Study was conducted for a period of one year, Jan 2017 – Dec 2017. Children in the age group 5 yrs. to 11 yrs. were included in the study. Results: Total prevalence of ear morbidities in children was found to be 15.8%. Wax impaction in the ears was found to be most prevalent morbidity 10.6%. Educational status of mother and head of the family, immunization status of child, history of slapping trauma and coryza were among the associated risk factors. Exclusive breast feeding was statistically insignificantly associated

Machine Learning Algorithms to Predict the Mortality of Carbapenem Resistant Klebsiella Pneumoniae bacteremia

2019 ◽  
Author(s):  
Qiqiang Liang ◽  
Fang Qian ◽  
Yibing Chen ◽  
Zhijun Xu ◽  
Zhijiang Xu ◽  
...  
Keyword(s):  
Machine Learning ◽  
Risk Factors ◽  
Septic Shock ◽  
High Risk ◽  
Klebsiella Pneumoniae ◽  
Severe Thrombocytopenia ◽  
Acute Renal Injury ◽  
High Risk Factors ◽  
Carbapenem Resistant ◽  
Logical Regression

Abstract Purpose To establish mortality prediction models in 14 days of Carbapenem-Resistant Klebsiella Pneumoniae bacteremia using Machine learning.Materials and Methods It is a single-center retrospective study. We collect the relevant clinical information of all patients with Carbapenem-Resistant Klebsiella Pneumoniae (CRKP) bacteremia in the past 5 years using the local database. Data analysis and verification are carried out by multiple logical regression, decision tree, random forest, support vector machine (SVM), and XGBoost.Result This study includes 187 patients with 40 related variables. In multiple logical regression, acute renal injury (P=0.003), Apache II score (P=0.036), immunodeficiency (P=0.025), severe thrombocytopenia (P=0.025) and septic shock (P=0.044) are the high-risk factors for 14 days mortality of CRKP bloodstream infections. According to the importance of those parameters, risk scoring is established to predict the survival rate of CRKP bacteremia. The analysis of the five models, with 70% training set and 30% test set, show the comprehensive performance of random forest (AUROC=0.953, precision=91.85%) is slightly better than that of XGBoost (AUROC=0.912, precision=86.41%) and SVM (AUROC=0.936, precision=79.89%) in predicting 14-day mortality of CRKP bacteremia. The multiple logical regression model (AUROC=0.825, precision=81.52%) is the second, and the decision tree model (AUROC=0.712, precision=79.89%) is not very ideal.Conclusion Machine learning has good performances in predicting 14-day mortality of CRKP bacteremia than multiple logical regression. Acute renal injury, severe thrombocytopenia, and septic shock are the high-risk factors of CRKP bacteremia mortality.

Outcomes of Carbapenem-Resistant Klebsiella pneumoniae Infection and the Impact of Antimicrobial and Adjunctive Therapies

2008 ◽  
Vol 29 (12) ◽  
pp. 1099-1106 ◽  
Author(s):  
Gopi Patel ◽  
Shirish Huprikar ◽  
Stephanie H. Factor ◽  
Stephen G. Jenkins ◽  
David P. Calfee
Keyword(s):  
Risk Factors ◽  
Klebsiella Pneumoniae ◽  
Case Control Study ◽  
Patient Survival ◽  
Case Control ◽  
Factors Associated ◽  
Carbapenem Resistant ◽  
Matched Case ◽  
The Impact ◽  
Control Study

Background.Carbapenem-resistant Klebsiella pneumoniae is an emerging healthcare-associated pathogen.Objective.To describe the epidemiology of and clinical outcomes associated with carbapenem-resistant K. pneumoniae infection and to identify risk factors associated with mortality among patients with this type of infection.Setting.Mount Sinai Hospital, a 1,171-bed tertiary care teaching hospital in New York City.Design.Two matched case-control studies.Methods.In the first matched case-control study, case patients with carbapenem-resistant K. pneumoniae infection were compared with control patients with carbapenem-susceptible K. pneumoniae infection. In the second case-control study, patients who survived carbapenem-resistant K. pneumoniae infection were compared with those who did not survive, to identify risk factors associated with mortality among patients with carbapenem-resistant K. pneumoniae infection.Results.There were 99 case patients and 99 control patients identified. Carbapenem-resistant K. pneumoniae infection was independently associated with recent organ or stem-cell transplantation (P = .008), receipt of mechanical ventilation (P = .04), longer length of stay before infection (P = .01), and exposure to cephalosporins (P = .02) and carbapenems (P < .001). Case patients were more likely than control patients to die during hospitalization (48% vs 20%; P < .001) and to die from infection (38% vs 12%; P < .001). Removal of the focus of infection (ie, debridement) was independently associated with patient survival (P = .002). The timely administration of antibiotics with in vitro activity against carbapenem-resistant K. pneumoniae was not associated with patient survival.Conclusions.Carbapenem-resistant K. pneumoniae infection is associated with numerous healthcare-related risk factors and with high mortality. The mortality rate associated with carbapenem-resistant K. pneumoniae infection and the limited antimicrobial options for treatment of carbapenem-resistant K. pneumoniae infection highlight the need for improved detection of carbapenem-resistant K. pneumoniae infection, identification of effective preventive measures, and development of novel agents with reliable clinical efficacy against carbapenem-resistant K. pneumoniae.

Renal Transplantation—A Tale of Two Cities

1980 ◽  
Vol 25 (4) ◽  
pp. 269-274
Author(s):  
R. F. M. Wood ◽  
P. R. F. Bell ◽  
J. Walls ◽  
J. R. Nash ◽  
D. S. MacPherson ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Survival Rate ◽  
Graft Survival ◽  
Initial Experience ◽  
Tissue Typing ◽  
Two Cities ◽  
Transplant Team ◽  
The Difference ◽  
One Year ◽  
The One

In 1974 three members of the transplant team from the Western Infirmary in Glasgow moved to the new medical school in Leicester. The initial experience with 33 patients transplanted in Glasgow was published in 1972 and this paper compares the results of that series with the first 21 patients grafted in Leicester. Despite improvements in tissue typing, better quality donor kidneys and fewer complications, there has been a failure to improve on the levels of graft survival. The overall one year graft survival rate in the Glasgow series was 79 per cent compared to 52 per cent in Leicester. In these two series the difference in results appears to be explained by blood transfusion. All the Glasgow patients had been poly-transfused but of the Leicester patients the 10 transfused pre-transplant had a one year graft survival of 90 per cent while in the 11 non-transfused patients the one year graft survival was only 18 per cent.

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