Prolonged Carriage of Carbapenemase-Producing Enterobacteriaceae: Clinical Risk Factors and the Influence of Carbapenemase and Organism Types

Prolonged carriage of carbapenemase-producing Enterobacteriaceae (CPE) constitutes a substantial epidemiologic threat. This study aimed to evaluate whether the types of carbapenemase and organism can affect the duration of carriage and to evaluate the clinical factors associated with prolonged carriage. We retrospectively reviewed data for patients admitted between May 2013 and August 2018 who were identified as CPE carriers. A total of 702 patients were identified; the major types of carbapenemase and organism were Oxacillinase (OXA)-48-like (n = 480, 68.4%) and Klebsiella pneumoniae (K. pneumoniae) (n = 584, 83.2%). The analyses of time to spontaneous decolonization using the Kaplan–Meier method showed that OXA-48-like and K. pneumoniae were significantly associated with prolonged carriage (log rank, p = 0.001 and p < 0.001). In multivariable logistic analysis to assess the risk factors for CPE prolonged carriage in the 188 patients with available follow-up culture data for 3 months, K. pneumoniae (adjusted odds ratio [aOR] 6.58; 95% confidence interval [CI], 1.05–41.27; p = 0.044), CPE positive clinical specimen (aOR 11.14; 95% CI, 4.73–26.25; p < 0.001), and concurrent Clostridioides difficile infection (CDI) (aOR 3.98, 95% CI 1.29–12.26; p = 0.016) were predictive of prolonged carriage. Our results suggest that CP-K. pneumoniae may have higher probability of prolonged carriage, while the effect of OXA-48-like CPE is inconclusive. Furthermore, patients with CP-K. pneumoniae who had positive clinical specimen or concurrent CDI can cause a vicious circle in prolonged carriage.

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Real-World Experience with Bezlotoxumab for Prevention of Recurrence of Clostridioides difficile Infection

Journal of Clinical Medicine ◽

10.3390/jcm10010002 ◽

2020 ◽

Vol 10 (1) ◽

pp. 2

Author(s):

Rosa Escudero-Sánchez ◽

María Ruíz-Ruizgómez ◽

Jorge Fernández-Fradejas ◽

Sergio García Fernández ◽

María Olmedo Samperio ◽

...

Keyword(s):

Clinical Trials ◽

Real World ◽

Recurrence Rates ◽

Factors Associated ◽

Clostridioides Difficile ◽

Multicentre Cohort Study ◽

Clostridioides Difficile Infection ◽

Prevention Of Recurrence ◽

Multicentre Cohort

Bezlotoxumab is marketed for the prevention of recurrent Clostridioides difficile infection (rCDI). Its high cost could be determining its prescription to a different population than that represented in clinical trials. The objective of the study was to verify the effectiveness and safety of bezlotoxumab in preventing rCDI and to investigate factors related to bezlotoxumab failure in the real world. A retrospective, multicentre cohort study of patients treated with bezlotoxumab in Spain was conducted. We compared the characteristics of cohort patients with those of patients treated with bezlotoxumab in the pivotal MODIFY trials. We assessed recurrence rates 12 weeks after completion of treatment against C. difficile, and we analysed the factors associated with bezlotoxumab failure. Ninety-one patients were included in the study. The cohort presented with more risk factors for rCDI than the patients included in the MODIFY trials. Thirteen (14.2%) developed rCDI at 12 weeks of follow-up, and rCDI rates were numerically higher in patients with two or more previous episodes (25%) than in those who had fewer than two previous episodes of C. difficile infection (CDI) (10.4%); p = 0.09. There were no adverse effects attributable to bezlotoxumab. Despite being used in a more compromised population than that represented in clinical trials, we confirm the effectiveness of bezlotoxumab for the prevention of rCDI.

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Comparative analysis of clinical factors associated with pedicle screw pull-out during or immediately after surgery between intraoperative cone-beam computed tomography and postoperative computed tomography

10.21203/rs.3.rs-52538/v5 ◽

2021 ◽

Author(s):

Satoshi Sumiya ◽

Kazuyuki Fukushima ◽

Yoshiro Kurosa ◽

Takashi Hirai ◽

Hiroyuki Inose ◽

...

Keyword(s):

Risk Factors ◽

Computed Tomography ◽

Pedicle Screw ◽

Odds Ratio ◽

Pedicle Screws ◽

Cone Beam ◽

Clinical Factors ◽

Factors Associated ◽

Pull Out ◽

History Of

Abstract Background No studies to date have elucidated the clinical factors associated with pedicle screw pull-out during or immediately after surgery. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with postoperative scans obtained using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors. Methods This was a retrospective analysis of prospectively collected data for 742 pedicle screws placed in 76 consecutive patients who underwent at least triple-level posterior fixation for thoracic or lumbar spinal injury, spinal metastasis, or pyogenic spondylitis between April 2014 and July 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. Risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis. Results Pedicle screw pull-out was seen with 58 pedicle screws (7.8%) in 26 patients (34.2%). There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), and medical history of osteoporosis for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.07, 95% confidence interval 1.02–1.130) and a diagnosis of DISH (odds ratio 3.35, 95% confidence interval 1.12–10.00). Several cases suggest that use of connecting rods was an important factor in intraoperative pedicle screw pull-out. Conclusions Our findings suggest that age, number of fused segments, presence of DISH, and medical history of osteoporosis are risk factors for pedicle screw pull-out, with the greatest being older age and DISH.

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Factors associated with non-vaccination against measles among 12-23 months old children in Yirgachefe district of SNNPR, Ethiopia, 2016

10.21203/rs.2.10399/v1 ◽

2019 ◽

Author(s):

Luna Habtamu Degife ◽

Yoseph Worku ◽

Muse Tadesse

Keyword(s):

Risk Factors ◽

Confidence Interval ◽

Odds Ratio ◽

Statistical Significance ◽

Southern Ethiopia ◽

Effective Vaccine ◽

Age Group ◽

Factors Associated ◽

Lack Of Knowledge

Abstract Immunization is an effective and proven tool for controlling and eliminating life-threatening vaccine preventable infectious diseases. In Ethiopia 5% of childhood mortalities are due to measles. In 2015, 85% of children had received 1 dose of measles vaccine by their second birthday. Despite the availability of a safe and effective vaccine, measles outbreaks secondary to non-vaccination are occurring in southern Ethiopia especially in Yirgachefe district.This study was done to assess the risk factors associated with non-vaccination against measles. A Community-based unmatched case control study was conducted in Yirgachefe district from December 1-31, 2016.Cases were defined as children in the age group of 12- 23 months of age who did not take measles vaccination. The study was done in 6 randomly selected kebeles and cases and controls were selected randomly by probability proportional to size sampling. A structured questionnaire was used for data collection and data was analyzed by using Epi info version 7 and SPSS version 20. Statistical significance was interpreted using Odds ratio with 95% confidence interval and P value <0.05. A total of 320 individuals (107 cases and 214 controls) were approached for interview with a response rate of 93.75%. Of the cases, 57% were males and more than half fall in the 12-18 months age group. Lack of Ante Natal Care follow up (Adjusted Odds Ratio (AOR) =3.57; 95% Confidence Interval (CI): 1.22-10.44), lack of knowledge on the importance of vaccination, who should be vaccinated and if measles is contagious with an AOR and CI of (AOR=6.81; 95% CI: 1.56-29.64), (AOR=4.29; 95% CI: 1.83-10.04) and (AOR=8.97; 95%CI: 3.15-25.58) respectively were independent risk factors. Lack of ANC follow up, lack of knowledge about who should get vaccinated, the importance of vaccination and contagiousness of the disease were identified as risk factors for non-vaccination against measles. Education and awareness about measles and its immunization should be given to the community. Additionally, ANC follow up should also be strengthened.

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Comparative analysis of clinical factors associated with pedicle screw pull-out during or immediately after surgery between intraoperative cone-beam computed tomography and postoperative computed tomography

10.21203/rs.3.rs-52538/v3 ◽

2020 ◽

Author(s):

Satoshi Sumiya ◽

Kazuyuki Fukushima ◽

Yoshiro Kurosa ◽

Takashi Hirai ◽

Hiroyuki Inose ◽

...

Keyword(s):

Risk Factors ◽

Computed Tomography ◽

Pedicle Screw ◽

Odds Ratio ◽

Pedicle Screws ◽

Cone Beam ◽

Clinical Factors ◽

Factors Associated ◽

Pull Out ◽

History Of

Abstract Background No studies to date have elucidated the clinical factors associated with pedicle screw pull-out during or immediately after surgery. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with postoperative scans obtained using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors.Methods This was a retrospective analysis of prospectively collected data for 742 pedicle screws placed in 76 consecutive patients who underwent at least triple-level posterior fixation for thoracic or lumbar spinal injury, spinal metastasis, or pyogenic spondylitis between April 2014 and July 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. Risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis.Results Pedicle screw pull-out was seen with 58 pedicle screws (7.8%) in 26 patients (34.2%). There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), and medical history of osteoporosis for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.07, 95% confidence interval 1.02–1.130) and a diagnosis of DISH (odds ratio 3.35, 95% confidence interval, 1.12–10.00). Several cases suggest that use of connecting rods was an important factor in intraoperative pedicle screw pull-out.Conclusions Our findings suggest that age, number of fused segments, the presence of DISH, and medical history of osteoporosis are risk factors for pedicle screw pull-out, with the greatest being older age and DISH.

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Prospective Study on Incidence, Risk Factors and Outcome of Recurrent Clostridioides difficile Infections

Journal of Clinical Medicine ◽

10.3390/jcm10051127 ◽

2021 ◽

Vol 10 (5) ◽

pp. 1127

Author(s):

Guido Granata ◽

Nicola Petrosillo ◽

Lucia Adamoli ◽

Michele Bartoletti ◽

Alessandro Bartoloni ◽

...

Keyword(s):

Risk Factors ◽

Incidence Rate ◽

Case Control Study ◽

Antimicrobial Treatment ◽

Clostridioides Difficile ◽

All Cause Mortality ◽

Clostridioides Difficile Infection ◽

Incidence Risk ◽

Control Study

Background: Limited and wide-ranging data are available on the recurrent Clostridioides difficile infection (rCDI) incidence rate. Methods: We performed a cohort study with the aim to assess the incidence of and risk factors for rCDI. Adult patients with a first CDI, hospitalized in 15 Italian hospitals, were prospectively included and followed-up for 30 d after the end of antimicrobial treatment for their first CDI. A case–control study was performed to identify risk factors associated with 30-day onset rCDI. Results: Three hundred nine patients with a first CDI were included in the study; 32% of the CDI episodes (99/309) were severe/complicated; complete follow-up was available for 288 patients (19 died during the first CDI episode, and 2 were lost during follow-up). At the end of the study, the crude all-cause mortality rate was 10.7% (33 deaths/309 patients). Two hundred seventy-one patients completed the follow-up; rCDI occurred in 21% of patients (56/271) with an incidence rate of 72/10,000 patient-days. Logistic regression analysis identified exposure to cephalosporin as an independent risk factor associated with rCDI (RR: 1.7; 95% CI: 1.1–2.7, p = 0.03). Conclusion: Our study confirms the relevance of rCDI in terms of morbidity and mortality and provides a reliable estimation of its incidence.

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Comparative analysis of clinical factors associated with pedicle screw pull-out between intraoperative cone-beam computed tomography and postoperative computed tomography

10.21203/rs.3.rs-52538/v1 ◽

2020 ◽

Author(s):

Satoshi Sumiya ◽

Kazuyuki Fukushima ◽

Yoshiro Kurosa ◽

Takashi Hirai ◽

Hiroyuki Inose ◽

...

Keyword(s):

Risk Factors ◽

Computed Tomography ◽

Confidence Interval ◽

Pedicle Screw ◽

Odds Ratio ◽

Pedicle Screws ◽

Cone Beam ◽

Clinical Factors ◽

Factors Associated ◽

Pull Out

Abstract Background No studies to date have elucidated the clinical factors associated with pedicle screw pull-out. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with scans acquired postoperatively using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors. Methods This was a retrospective analysis of prospectively collected data for 636 pedicle screws placed in 66 consecutive patients who underwent at least triple-level posterior fixation of the thoracic or lumbar spine between April 2014 and March 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. The risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis. Results Pedicle screw pull-out was seen with 17 pedicle screws (2.7%) in 13 (19.7%) patients. There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), presence of osteoporosis, and advanced elderly medical service system insurance for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.15, 95% confidence interval 1.04–1.272) and a diagnosis of DISH (odds ratio 6.10, 95% confidence interval, 1.23–30.20). Conclusions Several cases of intraoperative pedicle screw pull-out may be caused by use of connecting rods. Older age and DISH are risk factors for pedicle screw pull-out.

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Comparative analysis of clinical factors associated with pedicle screw pull-out during or immediately after surgery between intraoperative cone-beam computed tomography and postoperative computed tomography

10.21203/rs.3.rs-52538/v4 ◽

2020 ◽

Author(s):

Satoshi Sumiya ◽

Kazuyuki Fukushima ◽

Yoshiro Kurosa ◽

Takashi Hirai ◽

Hiroyuki Inose ◽

...

Keyword(s):

Risk Factors ◽

Computed Tomography ◽

Pedicle Screw ◽

Odds Ratio ◽

Pedicle Screws ◽

Cone Beam ◽

Clinical Factors ◽

Factors Associated ◽

Pull Out ◽

History Of

Abstract Background No studies to date have elucidated the clinical factors associated with pedicle screw pull-out during or immediately after surgery. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with postoperative scans obtained using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors.Methods This was a retrospective analysis of prospectively collected data for 742 pedicle screws placed in 76 consecutive patients who underwent at least triple-level posterior fixation for thoracic or lumbar spinal injury, spinal metastasis, or pyogenic spondylitis between April 2014 and July 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. Risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis.Results Pedicle screw pull-out was seen with 58 pedicle screws (7.8%) in 26 patients (34.2%). There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), and medical history of osteoporosis for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.07, 95% confidence interval 1.02–1.130) and a diagnosis of DISH (odds ratio 3.35, 95% confidence interval 1.12–10.00). Several cases suggest that use of connecting rods was an important factor in intraoperative pedicle screw pull-out.Conclusions Our findings suggest that age, number of fused segments, presence of DISH, and medical history of osteoporosis are risk factors for pedicle screw pull-out, with the greatest being older age and DISH.

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Prevalence and risk factors associated with non-attendance in neurodevelopmental follow-up clinic among infants with CHD

Cardiology in the Young ◽

10.1017/s1047951117002748 ◽

2018 ◽

Vol 28 (4) ◽

pp. 554-560 ◽

Cited By ~ 5

Author(s):

Eméfah C. Loccoh ◽

Sunkyung Yu ◽

Janet Donohue ◽

Ray Lowery ◽

Jennifer Butcher ◽

...

Keyword(s):

Risk Factors ◽

Cardiac Surgery ◽

High Risk ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Private Insurance ◽

Univariate Analysis ◽

Multivariable Analysis ◽

Factors Associated

AbstractBackgroundNeurodevelopmental impairment is increasingly recognised as a potentially disabling outcome of CHD and formal evaluation is recommended for high-risk patients. However, data are lacking regarding the proportion of eligible children who actually receive neurodevelopmental evaluation, and barriers to follow-up are unclear. We examined the prevalence and risk factors associated with failure to attend neurodevelopmental follow-up clinic after infant cardiac surgery.MethodsSurvivors of infant (<1 year) cardiac surgery at our institution (4/2011-3/2014) were included. Socio-demographic and clinical characteristics were evaluated in neurodevelopmental clinic attendees and non-attendees in univariate and multivariable analyses.ResultsA total of 552 patients were included; median age at surgery was 2.4 months, 15% were premature, and 80% had moderate–severe CHD. Only 17% returned for neurodevelopmental evaluation, with a median age of 12.4 months. In univariate analysis, non-attendees were older at surgery, had lower surgical complexity, fewer non-cardiac anomalies, shorter hospital stay, and lived farther from the surgical center. Non-attendee families had lower income, and fewer were college graduates or had private insurance. In multivariable analysis, lack of private insurance remained independently associated with non-attendance (adjusted odds ratio 1.85, p=0.01), with a trend towards significance for distance from surgical center (adjusted odds ratio 2.86, p=0.054 for ⩾200 miles).ConclusionsThe majority of infants with CHD at high risk for neurodevelopmental dysfunction evaluated in this study are not receiving important neurodevelopmental evaluation. Efforts to remove financial/insurance barriers, increase access to neurodevelopmental clinics, and better delineate other barriers to receipt of neurodevelopmental evaluation are needed.

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Comparative analysis of clinical factors associated with pedicle screw pull-out between intraoperative cone-beam computed tomography and postoperative computed tomography

10.21203/rs.3.rs-52538/v2 ◽

2020 ◽

Author(s):

Satoshi Sumiya ◽

Kazuyuki Fukushima ◽

Yoshiro Kurosa ◽

Takashi Hirai ◽

Hiroyuki Inose ◽

...

Keyword(s):

Risk Factors ◽

Computed Tomography ◽

Confidence Interval ◽

Pedicle Screw ◽

Odds Ratio ◽

Pedicle Screws ◽

Cone Beam ◽

Clinical Factors ◽

Factors Associated ◽

Pull Out

Abstract Background: No studies to date have elucidated the clinical factors associated with pedicle screw pull-out. The aim of this study was to assess the frequency of pedicle screw pull-out by comparing intraoperative scans obtained using cone-beam computed tomography (CBCT) with scans acquired postoperatively using computed tomography (CT). We also sought to determine the incidence of pedicle screw pull-out and identify relevant risk factors.Methods: This was a retrospective analysis of prospectively collected data for 742 pedicle screws placed in 76 consecutive patients who underwent at least triple-level posterior fixation for thoracic or lumbar spinal injury, spinal metastasis, or pyogenic spondylitis between April 2014 and July 2020. Pedicle screw pull-out distance in the axial and sagittal planes was compared between CT scans obtained 2 days postoperatively and CBCT images acquired intraoperatively. Risk factors associated with pedicle screw pull-out were investigated by multivariate logistic regression analysis.Results: Pedicle screw pull-out was seen with 58 pedicle screws (7.8%) in 26 (34.2%) patients. There were significant differences in age, number of fused segments, frequency of diffuse idiopathic skeletal hyperostosis (DISH), and medical history of osteoporosis for pedicle screw pull-out. Risk factors for pedicle screw pull-out were older age (odds ratio 1.07, 95% confidence interval 1.02–1.130) and a diagnosis of DISH (odds ratio 3.35, 95% confidence interval, 1.12–10.00).Conclusions: Several cases of intraoperative pedicle screw pull-out may be caused by use of connecting rods. Older age and DISH are risk factors for pedicle screw pull-out.

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