The Prevalence and Clinical Significance of Anaerobic Bacteria in Major Liver Resection

(1) Background: Anaerobic infections in hepatobiliary surgery have rarely been addressed. Whereas infectious complications during the perioperative phase of liver resections are common, there are very limited data on the prevalence and clinical role of anaerobes in this context. Given the risk of contaminated bile in liver resections, the goal of our study was to investigate the prevalence and outcome of anaerobic infections in major hepatectomies. (2) Methods: We retrospectively analyzed the charts of 245 consecutive major hepatectomies that were performed at the department of General, Visceral, and Transplantation Surgery of the University Hospital of Tuebingen between July 2017 and August 2020. All microbiological cultures were screened for the prevalence of anaerobic bacteria and the patients’ clinical characteristics and outcomes were evaluated. (3) Results: Of the 245 patients, 13 patients suffered from anaerobic infections. Seven had positive cultures from the biliary tract during the primary procedure, while six had positive culture results from samples obtained during the management of complications. Risk factors for anaerobic infections were preoperative biliary stenting (p = 0.002) and bile leaks (p = 0.009). All of these infections had to be treated by intervention and adjunct antibiotic treatment with broad spectrum antibiotics. (4) Conclusions: Anaerobic infections are rare in liver resections. Certain risk factors trigger the antibiotic coverage of anaerobes.

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1027. Vancomycin Use in Community-Acquired Pneumonia: Assessing Inappropriate Therapy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.891 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S361-S362

Author(s):

Timothy Shan ◽

Sara J Gore ◽

Caitlin M McCracken ◽

Gregory B Tallman ◽

Haley K Holmer ◽

...

Keyword(s):

Risk Factors ◽

Positive Culture ◽

Empiric Therapy ◽

Community Acquired Pneumonia ◽

University Hospital ◽

Inappropriate Therapy ◽

Definitive Therapy ◽

Days Of Therapy ◽

Risk Patients ◽

The Impact

Abstract Background Current Infectious Disease Society of America guidelines recommend anti-methicillin-resistant Staphylococcus aureus(MRSA) agents for treatment of community-acquired pneumonia (CAP) only in specific high-risk patients. There are limited data on duration of vancomycin use that is appropriate in hospitalized patients with CAP. The objective of this study was to evaluate the use of vancomycin for CAP among inpatients. Methods We conducted a retrospective cohort study of inpatients at Oregon Health and Science University Hospital from August 1st, 2017 to July 31st, 2018 who received IV vancomycin and had a pneumonia encounter ICD-9 diagnosis code. Patients with hospital or ventilator-associated pneumonia were excluded. Appropriate therapy was defined as empiric therapy with known risk-factors, concordant therapy with no de-escalation option, or concurrent sepsis or febrile neutropenia. Vancomycin appropriateness was assessed based on medical history and microbiology for both empiric and definitive therapy. We characterized patients receiving inappropriate therapy and calculated the proportion of inappropriate days of therapy (DOT). Results We identified 52 patients with CAP who were treated with vancomycin for a median of 2 DOT (Interquartile Range (IQR): 1–3). Approximately 21% (11/52) of patients had risk factors warranting vancomycin empiric therapy and 42% (22/52) had concurrent sepsis. Nine CAP patients received inappropriate courses of vancomycin, median of 1 day (IQR: 1–2.25) of inappropriate therapy. The most common reason for classifying use as inappropriate was a positive culture for organisms other than MRSA. Patients receiving inappropriate therapy were more frequently transferred from another hospital (44% vs. 30%, P = 0.22). Overall, 16% (20/125) of vancomycin DOT were inappropriate. Conclusion In our study,CAP patients accounted for a small number of pneumonia patients who received vancomycin. The median inappropriate DOT was relatively short, possibly indicating that identification and de-escalation was performed quickly. Further work is required to determine the impact of these findings on patients. Disclosures All authors: No reported disclosures.

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Comparison of risk factors and outcomes of Candida auris candidemia with non-Candida auris candidemia: A retrospective study from Pakistan

Medical Mycology ◽

10.1093/mmy/myz112 ◽

2019 ◽

Vol 58 (6) ◽

pp. 721-729 ◽

Cited By ~ 2

Author(s):

Muneeba Ahsan Sayeed ◽

Joveria Farooqi ◽

Kauser Jabeen ◽

Syed Faisal Mahmood

Keyword(s):

Risk Factors ◽

Retrospective Study ◽

Hospital Stay ◽

Candida Species ◽

Antifungal Susceptibility ◽

Positive Culture ◽

University Hospital ◽

Prior History ◽

P Value ◽

Candida Auris

Abstract Candida auris has emerged as a nosocomial multi-drug resistant pathogen. This study aimed to compare the risk factors and outcomes of C. auris candidemia patients with non-C. auris candidemia, at a single center in Pakistan. A retrospective study compared 38 C. auris with 101 non-C. auris (36 C. albicans, 38 C. tropicalis, and 27 C. parapsilosis) candidemia patients between September 2014 and March 2017 at the Aga Khan University Hospital, Pakistan. Demographics, clinical history, management and outcomes were studied. Prior history of surgery (adjusted odds ratio [aOR] 4.9, 95% confidence interval [CI]: 1.4–17.5), antifungals exposure (aOR 38.3, 95% CI: 4.1–356) and prior MDR bacteria isolation (aOR 5.09, 95% CI: 1.6–15.9) were associated with C. auris candidemia. On survival analysis both groups of patients had similar outcome in terms of mortality (62.6% vs. 52.54%, hazard ratio [HR] 1.45, 95% CI: 0.84–2.4, P-value = .17) and microbiological failure rates (42.3% vs. 32.2%, HR 0.65, 95% CI: 0.35–1.2, P-value = .17) however, C. auris patients had a higher mean hospital stay (36.32 days vs. 14.8 days, P-value = <.001) and higher >15-day in-hospital stay from positive culture (HR 2.68, 95% CI: 1.1–6.3, P-value = .025). Antifungal susceptibility was different, with C. auris more often resistant to voriconazole (29.6% vs. 0%) and amphotericin (3.7 vs. 0%); though no echinocandin resistance was detected in either group. As opposed to other Candida species, C. auris candidemia occurred after nosocomial exposure, and its source was most commonly an indwelling line. Although these patients had a higher in-hospital stay, but there was no excess mortality when compared to other Candida species.

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Infectious complications secondary to prostate biopsy

Urology & Nephrology Open Access Journal ◽

10.15406/unoaj.2021.09.00307 ◽

2021 ◽

Vol 9 (2) ◽

pp. 47-51

Author(s):

Mzyiene x Mzyiene Mohammed ◽

Ziba Ouima Justin Dieudonné ◽

Mustapha Ahsaini ◽

Mellas Soufiane ◽

Mohammed Fadl Tazi ◽

...

Keyword(s):

Septic Shock ◽

Prostate Biopsy ◽

Specific Antigen ◽

Anaerobic Bacteria ◽

Asymptomatic Bacteriuria ◽

Infectious Complications ◽

University Hospital ◽

Resistant Bacteria ◽

Klebsiella Pneumonia ◽

Good Improvement

Introduction: Prostate biopsy (PB) is a routine procedure performed by urologists in cases of suspected prostate cancer, any abnormality in the prostate-specific antigen (PSA) assay, and/or perceived by the digital rectal exam. Although this is a safe and rapid procedure, it is not without potentially serious complications, including infectious complications ranging from asymptomatic bacteriuria to acute prostatitis and even septic shock. Materials and methods: This work reports the experience of the urology department of the Hassan II University Hospital of Fez in the study of post-biopsy prostatitis through the analysis of a retrospective series of 538 cases during the period January 2014 - December 2018. Results: We report 11 cases of acute post-biopsy prostatitis diagnosed in the urology department of the Hassan II University Hospital in Fez. The bacteria most frequently involved in post-biopsy infections are gram-negative bacteria (Escherichia coli, Klebsiella pneumonia, Acinetobacter baumannii) although gram-positive cocci (Enterococcus faecalis and Staphylococcus saprophyticus) can also be responsible. Anaerobic bacteria are rarely found. The treatment of these post-biopsy infections is based on prolonged antibiotic therapy (3 to 6 weeks) using third-generation cephalosporins (Ceftriaxone). In our series, no death, septic shock, or prostatic abscess was found. The evolution was towards a good improvement under antibiotic treatment with discharge at home after 48 hours of apyrexia. Conclusion: The study of infectious complications secondary to prostate biopsy makes it possible to determine the most appropriate empirical (therapeutic and prophylactic) regimens to minimize the risks. Because of the prevalence of infection by multi-resistant bacteria, particularly to quinolones, the biopsy must be performed following the rules of antibiotic prophylaxis.

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Risk Factors and Outcome of Pretrem Labor in Pregnant Women Attending Zagazig Maternity University Hospital

Zagazig University Medical Journal ◽

10.21608/zumj.2020.22658.1699 ◽

2020 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Hassan Hassan Nassar ◽

Ali Ali ◽

Sherin Shazly ◽

Ahmed Mansour

Keyword(s):

Risk Factors ◽

Pregnant Women ◽

University Hospital

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Prevalence of and Risk Factors for Low Free Testosterone Levels in Japanese Men with Well-controlled Human Immunodeficiency Virus Infection

Current HIV Research ◽

10.2174/1570162x18666200720000344 ◽

2020 ◽

Vol 18 (5) ◽

pp. 381-386

Author(s):

Yusuke Yoshino ◽

Ichiro Koga ◽

Yoshitaka Wakabayashi ◽

Takatoshi Kitazawa ◽

Yasuo Ota

Keyword(s):

Risk Factors ◽

Human Immunodeficiency Virus ◽

Standard Deviation ◽

Hiv Infection ◽

Free Testosterone ◽

Serum Levels ◽

University Hospital ◽

Rapid Decline ◽

Total Testosterone ◽

Immunodeficiency Virus

Background: The change in the prevalence of hypogonadism with age in men with human immunodeficiency virus (HIV) infection is subject to debate. Objective: To address this issue, we diagnosed hypogonadism based on serum levels of free testosterone (fTST) rather than total testosterone which is thought to be an inaccurate indicator. We also determined the relationship between age and fTST levels and identified risk factors for hypogonadism in men with HIV infection. Method: We retrospectively reviewed fTST levels and associated clinical factors in 71 wellcontrolled HIV-infected men who were treated at Teikyo University Hospital between April 2015 and March 2016 and who had data available on serum fTST levels, measured >6 months after starting antiretroviral therapy. fTST was measured using radioimmunoassay on blood samples collected in the morning. Risk factors for hypogonadism were identified using Welch’s t-test and multiple regression analysis. Results: The men had a mean (± standard deviation) age of 47.4 ± 13.6 years, and mean (± standard deviation) serum fTST level of 13.0 ± 6.1 pg/mL. Fifteen (21.1%) men had hypogonadism based on a fTST <8.5 pg/mL. Serum fTST levels significantly decreased with age (−0.216 pg/mL/year). Older age and low hemoglobin levels were identified as risk factors for hypogonadism. Conclusion: The men in the study experienced a more rapid decline in fTST levels with age than men in the general population (−0.161 pg/mL/year). Serum fTST levels in men with HIV infection should be monitored, especially in older men and those with low hemoglobin levels.

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Non-alcoholic fatty liver disease in polycystic ovary syndrome women

Scientific Reports ◽

10.1038/s41598-021-86697-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Young Bin Won ◽

Seok Kyo Seo ◽

Bo Hyon Yun ◽

SiHyun Cho ◽

Young Sik Choi ◽

...

Keyword(s):

Risk Factors ◽

Liver Disease ◽

Fatty Liver ◽

Liver Enzyme ◽

Fatty Liver Disease ◽

Polycystic Ovary ◽

Insulin Level ◽

University Hospital ◽

Alcoholic Fatty Liver ◽

Alcoholic Fatty Liver Disease

AbstractTo evaluate risk factors leading to non-alcoholic fatty liver disease (NAFLD) occurrence in polycystic ovarian syndrome (PCOS) women. A retrospective cohort study of a total of 586 women diagnosed with PCOS aged 13–35 years at the gynecology department at a university hospital was done to evaluate PCOS phenotype, metabolic syndrome (MetS) diagnosis, body composition, insulin sensitivity, sex hormones, lipid profile, liver function, and transient elastography (TE). In PCOS women with NAFLD compared to those without, MetS diagnosis (Hazard ratio [HR] 5.6, 95% Confidence interval [CI] 2.2–14.4, p < 0.01) and hyperandrogenism (HA) (HR 4.4, 95% CI 1.4–13.4, p = 0.01) were risk factors significantly associated with subsequent NAFLD occurrence, whereas 2-h insulin level in 75 g glucose tolerance test (GTT) (HR 1.2, 95% CI 0.5–2.5, p = 0.70) and body mass index (BMI) > 25 kg/m2 (HR 2.2, 95% CI 0.6–8.0, p = 0.24) was not. Among NAFLD patients who underwent TE, a higher number of MetS components indicated a worse degree of fibrosis and steatosis. MetS diagnosis and HA at PCOS diagnosis were risk factors associated with NAFLD, while 2-h insulin level in 75 g GTT and obesity were not. Although elevated aspartate aminotransferase levels were significant for NAFLD risk, liver enzyme elevations may not be present until late liver damage. Further prospective studies of PCOS women with MetS or HA are warranted to determine whether patients without liver enzyme elevations should undergo preemptive liver examinations.

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Oxidative stress in common variable immunodeficiency

European Journal of Inflammation ◽

10.1177/20587392211002411 ◽

2021 ◽

Vol 19 ◽

pp. 205873922110024

Author(s):

Sevgen Tanir Basaranoglu ◽

Sukru Cekic ◽

Emine Kirhan ◽

Melahat Dirican ◽

Sara S. Kilic

Keyword(s):

Oxidative Stress ◽

Common Variable Immunodeficiency ◽

Chronic Inflammatory Demyelinating Polyneuropathy ◽

Infectious Complications ◽

Clinical Syndrome ◽

University Hospital ◽

Unknown Etiology ◽

Healthy Controls ◽

Oxidative Stress Biomarkers ◽

Common Variable

Common variable immunodeficiency (CVID) is a heterogenous group of immunologic disorders of unknown etiology. Alterations of the normal cellular balance due to an increase in reactive oxygen species and/or decrease in antioxidant defense may lead to increased oxidative stress. We aimed to evaluate the levels of oxidative stress biomarkers in patients with CVID who had different presentations. We investigated the serum catalase (CAT), erythrocyte superoxide dismutase (SOD), erythrocyte reduced glutathione as antioxidants and serum malondialdehyde levels as lipid peroxidation marker in patients with CVID in Uludag University Hospital Department of Pediatric Allergy and Immunology’s outpatient clinics. In the analysis, there were 21 patients and 27 matched healthy controls. The median levels of CAT in patients with CVID was significantly lower than in healthy controls ( p = 0.04). Among the patients with CVID, 19% had autoimmune disease, one had Sjögren’s syndrome, one had autoimmune alopecia, one had juvenile rheumatoid arthritis, and one had chronic inflammatory demyelinating polyneuropathy. Patients with autoimmune complications had significantly lower CAT levels compared to the ones without autoimmune diseases ( p = 0.03). The patients without non-infectious complications (NICs) had lower SOD levels than the patients with NICs ( p = 0.05). The analysis of oxidative stress markers in the patients with CVID suggested a series of abnormalities in the anti-oxidant system. The clinical syndrome associations may be a useful tool for future studies to set prediction markers for the prognosis of patients with CVID.

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Assessing burden, risk factors, and perceived impact of uterine fibroids on women’s lives in rural Haiti: implications for advancing a health equity agenda, a mixed methods study

International Journal for Equity in Health ◽

10.1186/s12939-020-01327-9 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Christophe Millien ◽

Anatole Manzi ◽

Arlene M. Katz ◽

Hannah Gilbert ◽

Mary C. Smith Fawzi ◽

...

Keyword(s):

Risk Factors ◽

Mixed Methods ◽

Black Women ◽

Uterine Fibroids ◽

Mixed Methods Study ◽

University Hospital ◽

Gynecologic Surgery ◽

Cross Sectional ◽

Women's Lives

Abstract Background Uterine fibroids, the most common cause of gynecologic surgery, have a reported cumulative incidence of 59% among Black women in the U.S. Uterine fibroids negatively impact the quality of women’s lives. No study has been found in the literature about fibroids in Haiti. We conducted a mixed methods study to assess the burden and risk factors of uterine fibroids, as well as their effects on women’s quality of life. Methods A convergent mixed methods study was conducted between October 1, 2019 and January 31, 2020 at MUH’s (Mirebalais University Hospital) OB-GYN outpatient department. Quantitatively, in a cross-sectional study 211 women completed consecutively a structured questionnaire. In-depth interviews with 17 women with fibroids and 7 family members were implemented for the qualitative component. Descriptive statistics were calculated for clinical and social demographic variables. Logistic regression was performed to examine associations between fibroids and related risk factors. An inductive thematic process was used to analyze the qualitative data. A joint display technique was used to integrate the results. Results Of 193 women analyzed 116 had fibroids (60.1%). The mean age was 41.3. Anemia was the most frequent complication— 61 (52.6%). Compared to women without uterine fibroids, factors associated with uterine fibroids included income decline (AOR = 4.7, 95% CI: 2.1–10.9, p = < 0.001), excessive expenses for transport (AOR = 4.4, 95% CI: 1.6–12.4, p = 0.005), and family history with uterine fibroids (AOR = 4.6, 95% CI: 1.6–13.6, p = 0.005). In contrast, higher level of education and micro polycystic ovarian syndrome were associated with lower prevalence (AOR = 0.3, 95% CI: 0.1–0.9, p = 0.021) and (AOR = 0.2, 95% CI: 0.1–0.97, p = 0.044), respectively. The qualitative findings delineate how contextual factors such as health system failures, long wait times, gender inequality and poverty negatively affect the quality of women’s lives. The poverty cycle of uterine fibroids emerged. Conclusions A vicious cycle of poverty negatively impacts access to care for uterine fibroids in Haiti. Health insurance, social support, and income generating activities may be keys to promote social justice through access to adequate care for women with uterine fibroids in Haiti.

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Burnout Syndrome during Residency Training in Jordan: Prevalence, Risk Factors, and Implications

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041557 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1557

Author(s):

Abdullah Nimer ◽

Suzan Naser ◽

Nesrin Sultan ◽

Rawand Said Alasad ◽

Alexander Rabadi ◽

...

Keyword(s):

Risk Factors ◽

Working Hours ◽

Cross Sectional Study ◽

University Hospital ◽

Burnout Syndrome ◽

Online Questionnaire ◽

Cross Sectional ◽

Factors Associated ◽

Resident Physicians ◽

Healthcare Professions

Burnout syndrome is common among healthcare professions, including resident physicians. We aimed to assess the prevalence of burnout among resident physicians in Jordan, and a secondary aim was to evaluate the risk factors associated with the development of burnout syndrome in those residents, including gender, working hours, psychological distress, training sector, and specialty. In this cross-sectional study, 481 residents were recruited utilizing multistage stratified sampling to represent the four major health sectors in Jordan. Data were collected using an online questionnaire, where the Copenhagen Burnout Inventory (CBI) was used to assess the prevalence of burnout. The prevalence, group differences, and predictors of burnout were statistically analyzed using STATA 15. Overall, 373 (77.5%) residents were found to have burnout. Factors associated with higher levels of burnout were psychological stress (β = 2.34, CI = [1.88–2.81]), longer working hours (β = 4.07, CI = [0.52–7.62], for 51–75 h a week, β = 7.27, CI = [2.86–11.69], for 76–100 h a week and β = 7.27, CI = [0.06–14.49], for >100 h a week), and obstetrics/gynecology residents (β = 9.66, CI = [3.59–15.73]). Conversely, medical sub-specialty residents, as well as private and university hospital residents, had lower burnout levels. We concluded that decreasing the workload on residents, offering psychological counseling, and promoting a safety culture for residents might help in mitigating burnout consequences.

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Two dominant patterns of low anterior resection syndrome and their effects on patients’ quality of life

Scientific Reports ◽

10.1038/s41598-021-82149-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Min Jung Kim ◽

Ji Won Park ◽

Mi Ae Lee ◽

Han-Ki Lim ◽

Yoon-Hye Kwon ◽

...

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Anterior Resection ◽

Low Anterior Resection ◽

University Hospital ◽

Postoperative Treatment ◽

Low Anterior Resection Syndrome ◽

Cross Sectional ◽

Anterior Resection Syndrome

AbstractTo identify low anterior resection syndrome (LARS) patterns and their associations with risk factors and quality of life (QOL). This cross-sectional study analyzed patients who underwent restorative anterior resection for left-sided colorectal cancer at Seoul National University Hospital, Seoul, Republic of Korea. We administered LARS questionnaires to assess bowel dysfunction and quality of life between April 2017 and November 2019. LARS patterns were classified based on factor analyses. Variable effects on LARS patterns were estimated using logistic regression analysis. The risk factors and quality of life associated with dominant LARS patterns were analyzed. Data of 283 patients with a median follow-up duration of 24 months were analyzed. Major LARS was observed in 123 (43.3%) patients. Radiotherapy (odds ratio [OR]: 2.851, 95% confidence interval [95% CI]: 2.504–43.958, p = 0.002), low anastomosis (OR: 10.492, 95% CI: 2.504–43.958, p = 0.001), and complications (OR: 2.163, 95% CI: 1.100–4.255, p = 0.025) were independently associated with major LARS. LARS was classified into incontinence- or frequency-dominant types. Risk factors for incontinence-dominant LARS were radiotherapy and complications, whereas those for frequency-dominant LARS included low tumor location. Patients with incontinence-dominant patterns showed lower emotional function, whereas those with frequency-dominant patterns showed lower global health QOL, lower emotional, cognitive, and social functions, and higher incidence of pain and diarrhea. Frequency-dominant LARS had a greater negative effect on QOL than incontinence-dominant LARS. These patterns could be used for preoperative prediction and postoperative treatment of LARS.

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