scholarly journals Risk Factors for Mortality in Patients with Elizabethkingia Infection and the Clinical Impact of the Antimicrobial Susceptibility Patterns of Elizabethkingia Species

2020 ◽  
Vol 9 (5) ◽  
pp. 1431 ◽  
Author(s):  
Hye Seong ◽  
Jung Ho Kim ◽  
Jun Hyoung Kim ◽  
Woon Ji Lee ◽  
Jin Young Ahn ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Antimicrobial Susceptibility ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Intrinsic Resistance ◽  
Albumin Ratio ◽  
Saps Ii ◽  
Saps Ii Score ◽  
Susceptibility Patterns

Elizabethkingia species (spp.), which can colonize hospital environments, are emerging nosocomial pathogens presenting high mortality. Due to their intrinsic resistance to a broad range of antibiotics, optimal antibiotic dosage has yet to be determined against infections caused by Elizabethkingia spp. This study aimed to investigate the risk factors for the mortality of infections caused by Elizabethkingia spp. and assess the clinical implications of their antimicrobial susceptibility patterns. Data from 210 patients affected by Elizabethkingia-induced pneumonia and bacteremia between 1 November 2005 and 31 May 2016, were analyzed. Further antimicrobial susceptibility tests for moxifloxacin, rifampin, and vancomycin using Elizabethkingia isolates were performed to compensate for the Elizabethkingia spp. susceptibility panel in patients affected after 2013. The mean age of the patients was 66.5 ± 18 years and the 28-day mortality rate was 25.2% (53/210). In the univariate analysis, history of prior stay in an intensive care unit, central venous catheter use, presented thrombocytopenia, immunocompetent status, a high simplified acute physiology score II (SAPS II score), a high C-reactive protein (CRP)/albumin ratio on the day of isolation and seven days later, and a high minimum inhibitory concentration (MIC) value of rifampin were significantly associated with a higher mortality rate. In the multivariate logistic regression analysis, the MIC values of rifampin (odds ratio (OR): 1.045; 95% confidence interval (CI): 1.006–1.085; p = 0.023), SAPS II score (OR: 1.053; 95% CI: 1.022–1.084; p = 0.001), and initial CRP/albumin ratio (OR: 1.030; 95% CI: 1.009–1.051; p = 0.004) were significantly associated with 28-day mortality. To reduce the mortality associated with Elizabethkingia infections, prediction of the clinical course using initial CRP/albumin ratio and SAPS II and early intervention are essential. Rifampin is a promising candidate as the drug of choice in treating Elizabethkingia infections.

scholarly journals Clinical Value of the Lactate/Albumin Ratio and Lactate/Albumin Ratio × Age Score in the Assessment of Prognosis in Patients With Sepsis

2021 ◽  
Vol 8 ◽  
Author(s):  
Xiaonan Chen ◽  
Xinjian Zhou ◽  
Hui Zhao ◽  
Yanxue Wang ◽  
Hong Pan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Survival Curve ◽  
Multivariate Logistic Regression Analysis ◽  
Multivariate Logistic Regression ◽  
Survival Group ◽  
Albumin Ratio ◽  
Saps Ii ◽  
Death Group

Objective: To examine the clinical significance of the blood lactate (Lac)/serum albumin (Alb) ratio and the Lac/Alb × age score for assessing the severity and prognosis of patients with sepsis.Methods: A total of 8,029 patients with sepsis, aged >18 years were enrolled between June 2001 to October 2012 from the latest version of the Medical Information Mart for Intensive Care III (MIMIC-III v.1.4). The general data of the patients were obtained from hospital records and included gender, age, body mass index (BMI), laboratory indices, the sequential organ failure assessment (SOFA) score, and simplified acute physiology score II (SAPS II). The patients were graded and scored according to their age and then divided into a survival or death group based on their prognosis. The Lac/Alb ratio after ICU admission was calculated and compared between the two groups. The risk factors for death in patients with sepsis were determined using multivariate logistic regression analysis, while mortality was examined using receiver operating characteristic (ROC) curve and survival curve plots. Finally, the values of the Lac/Alb ratio and Lac/Alb × age score for assessing prognosis of patients with sepsis were analyzed and compared.Results: After items with default values were excluded, a total of 4,555 patients with sepsis were enrolled (2,526 males and 2,029 females). 2,843 cases were classified as the death group and 1,712 cases in the survival group. (1) The mean age, BMI, SOFA and SAPS II scores were higher in the death group than those in the survival group. Significant differences in baseline data between the two groups were also observed. (2) The patients in the death group were divided further into four subgroups according to the quartile of the Lac/Alb ratio from low to high. Comparison of the four subgroups showed that the death rate rose with an increase in the Lac/Alb ratio, while analysis of the survival curve revealed that patients with a higher Lac/Alb ratio had a worse prognosis. (3) Multivariate logistic regression analysis showed that age ≥ 60 years, overweight (BMI ≥ 24 kg/m2), Lac/Alb ratio ≥ 0.16, SOFA score ≥ 2 points, and SAPS II ≥ 40 points were independent risk factors for death in patients with septic. (4) ROC curve analysis indicated that the SAPS II, Lac/Alb x age score, SOFA, and Lac/Alb ratio were the best predictors of death in patients with sepsis. The Lac/Alb × age score was characterized by its simple acquisition and ability to quickly analyze the prognosis of patients.Conclusion: (1)A high Lac/Alb ratio is an independent risk factor for death in patients with sepsis. (2) Although the prognosis of sepsis can be accurately and comprehensively assessed by multi-dimensional analysis of multiple indices, the Lac/Alb×age score is more accurate and convenient for providing a general assessment of prognosis, so is worthy of further clinical recognition.

scholarly journals A population-based exposure assessment of risk factors associated with gastrointestinal pathogens: a Campylobacter study

2012 ◽  
Vol 141 (5) ◽  
pp. 976-986 ◽  
Author(s):  
L. A. MacRITCHIE ◽  
C. J. HUNTER ◽  
N. J. C. STRACHAN
Keyword(s):  
Risk Factors ◽  
Population Density ◽  
Exposure Assessment ◽  
Disease Incidence ◽  
Univariate Analysis ◽  
Age Groups ◽  
Multivariate Logistic Regression Analysis ◽  
Environmental Water ◽  
Population Based ◽  
Elevated Exposure

SUMMARYA questionnaire survey was undertaken to determine the exposure of a study population to campylobacteriosis source risk factors (environmental, water, food) and results were stratified by age, population density and deprivation. Data were gathered using an exposure assessment carried out by telephone in the Grampian region of Scotland. Univariate analysis showed that children aged 5–14 years, living in low population density (0–44·4 persons/km2) and affluent areas had elevated exposure to environmental and water risk factors. Multivariate logistic regression analysis revealed that younger age groups and lower population density were significant indicators for most environmental risk factors. The results compared to reported disease incidence in Grampian showed that greater exposure to risk factors does not necessarily coincide with greater disease incidence for age groups, particularly for the 0–4 years age group. Further research is required to explain the relationship between exposure and disease incidence.

scholarly journals Poor outcome of octogenarians admitted to ICU due to periprosthetic joint infections: a retrospective cohort study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Emre Yilmaz ◽  
Alexandra Poell ◽  
Hinnerk Baecker ◽  
Sven Frieler ◽  
Christian Waydhas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Joint Infection ◽  
Invasive Ventilation ◽  
Very Elderly ◽  
Saps Ii ◽  
Poor Outcome ◽  
Joint Infections ◽  
Saps Ii Score ◽  
The Mean

Abstract Background Even though surgical techniques and implants have evolved, periprosthetic joint infection (PJI) remains a serious complication leading to poor postoperative outcome and a high mortality. The literature is lacking in studies reporting the mortality of very elderly patients with periprosthetic joint infections, especially in cases when an intensive care unit (ICU) treatment was necessary. We therefore present the first study analyzing patients with an age 80 and higher suffering from a periprosthetic joint infection who had to be admitted to the ICU. Methods All patients aged 80 and higher who suffered from a PJI (acute and chronic) after THR or TKR and who have been admitted to the ICU have been included in this retrospective, observational, single-center study. Results A total of 57 patients met the inclusion criteria. The cohort consisted of 24 males and 33 females with a mean age of 84.49 (± 4.0) years. The mean SAPS II score was 27.05 (± 15.7), the mean CCI was 3.35 (± 2.28) and the most patient had an ASA score of 3 or higher. The PJI was located at the hip in 71.9% or at the knee in 24.6%. Two patients (3.5%) suffered from a PJI at both locations. Sixteen patients did not survive the ICU stay. Non-survivors showed significantly higher CCI (4.94 vs. 2.73; p = 0.02), higher SAPS II score (34.06 vs. 24.32; p = 0.03), significant more patients who underwent an invasive ventilation (132.7 vs. 28.1; p = 0.006) and significantly more patients who needed RRT (4.9% vs. 50%; p < 0.001). In multivariate analysis, RRT (odds ratio (OR) 15.4, CI 1.69–140.85; p = 0.015), invasive ventilation (OR 9.6, CI 1.28–71.9; p = 0.028) and CCI (OR 1.5, CI 1.004–2.12; p = 0.048) were independent risk factors for mortality. Conclusion Very elderly patients with PJI who needs to be admitted to the ICU are at risk to suffer from a poor outcome. Several risk factors including a chronic infection, high SAPS II Score, high CCI, invasive ventilation and RRT might be associated with a poor outcome.

scholarly journals Risk factors for a first thrombotic event in antiphospholipid antibody carriers: a prospective multicentre follow-up study

2011 ◽  
Vol 70 (6) ◽  
pp. 1083-1086 ◽  
Author(s):  
Amelia Ruffatti ◽  
Teresa Del Ross ◽  
Manuela Ciprian ◽  
Maria T Bertero ◽  
Sciascia Salvatore ◽  
...  
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Univariate Analysis ◽  
Thrombotic Event ◽  
Multivariate Logistic Regression Analysis ◽  
Antiphospholipid Antibody ◽  
History Of ◽  
Ischaemic Attack ◽  
Independent Risk Factors

ObjectivesTo assess risk factors for a first thrombotic event in confirmed antiphospholipid (aPL) antibody carriers and to evaluate the efficacy of prophylactic treatments.MethodsInclusion criteria were age 18–65 years, no history of thrombosis and two consecutive positive aPL results. Demographic, laboratory and clinical parameters were collected at enrolment, once a year during the follow-up and at the time of the thrombotic event, whenever that occurred.Results258 subjects were prospectively observed between October 2004 and October 2008. The mean±SD follow-up was 35.0±11.9 months (range 1–48). A first thrombotic event (9 venous, 4 arterial and 1 transient ischaemic attack) occurred in 14 subjects (5.4%, annual incidence rate 1.86%). Hypertension and lupus anticoagulant (LA) were significantly predictive of thrombosis (both at p<0.05) and thromboprophylaxis was significantly protective during high-risk periods (p<0.05) according to univariate analysis. Hypertension and LA were identified by multivariate logistic regression analysis as independent risk factors for thrombosis (HR 3.8, 95% CI 1.3 to 11.1, p<0.05, and HR 3.9, 95% CI 1.1 to 14, p<0.05, respectively).ConclusionsHypertension and LA are independent risk factors for thrombosis in aPL carriers. Thromboprophylaxis in these subjects should probably be limited to high-risk situations.

scholarly journals Toxoplasma gondii antibodies and related risk factors in mammals at Sorocaba zoo, São Paulo, BrazilToxoplasma gondii antibodies and related risk factors in mammals at Sorocaba zoo, São Paulo, Brazil

2017 ◽  
Vol 38 (4Supl1) ◽  
pp. 2845
Author(s):  
Renata Bezerra Marujo ◽  
Helio Langoni ◽  
Leila Sabrina Ullmann ◽  
Maysa Pellizzaro ◽  
Ramiro Das Neves Dias Neto ◽  
...  
Keyword(s):  
Risk Factors ◽  
Toxoplasma Gondii ◽  
Feeding Habits ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Sao Paulo ◽  
São Paulo ◽  
Intermediate Hosts ◽  
Serum Samples ◽  
Related Risk

Toxoplasmosis is a parasitic zoonosis with worldwide distribution and different wild species either are involved in maintenance of the pathogen in the environment as definitive or intermediate hosts serving as font of feeding or prey to definitive hosts. The present study aimed to investigate Toxoplasma gondii antibodies and the risk factors relating to infection in mammals at Sorocaba Zoo, state of São Paulo, Brazil. Serum samples collected from 153 animals were analyzed using the modified agglutination test (MAT; cutoff ? 25). Seropositivity was found in 62 animals (40.5%; 95% CI: 33.1-48.5%), with different titers. Significant differences were observed in relation to the ages of the animals, origin, presence of free-ranging animals in the enclosure and feeding habits, through univariate analysis (p ? 0.05). Multivariate logistic regression analysis showed that only age (p = 0.03) had significance for the study. Adult animals were 3.5 more likely to become infected than were young ones. In relation to feeding habits, herbivores (80%) and carnivores (46.5%) were the animals most affected. These results highlight the presence of T. gondii in animals at Brazilian zoos, and suggest that continuous transmission is occurring at zoos.

scholarly journals Frequency and antibiotic susceptibility patterns of urinary pathogens in male outpatients in Argentina

2014 ◽  
Vol 8 (06) ◽  
pp. 699-704 ◽  
Author(s):  
Hugo E Villar ◽  
Mónica B Jugo ◽  
Alejandro Macan ◽  
Matias Visser ◽  
Mariana Hidalgo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Adult Male ◽  
Antimicrobial Susceptibility ◽  
Antibiotic Susceptibility ◽  
Urine Samples ◽  
Diffusion Method ◽  
Bacterial Strains ◽  
Gram Negative ◽  
Antibiotic Susceptibility Patterns ◽  
Susceptibility Patterns

Introduction: Knowledge of the etiology and antimicrobial susceptibility patterns of uropathogens is important for determining the best treatment option. This study aimed to determine the distribution and antibiotic susceptibility patterns of bacterial strains isolated from adult male outpatients. Methodology: Between November 2012 and April 2013, 3,105 community urine samples were analyzed from adult male patients who attended the Laboratorio Hidalgo, Buenos Aires, Argentina. Antimicrobial susceptibility testing was performed by the Kirby-Bauer disc diffusion method. Isolates resistant to third generation cephalosporin were tested for extended-spectrum beta-lactamase (ESBL) production using the double-disk synergy test. Results: Of the 3,105 urine samples analyzed, 791 (25.5%) had significant bacteriuria. The frequency of positive urine cultures increased significantly with patient age. Escherichia coli was isolated most frequently (47.3%), followed by Enterococcus faecalis (13.6%), and Klebsiella pneumoniae (11.9%). Gram-negative organisms represented 78.8% of urinary pathogens. The highest activities against Gram-negative bacteria were found with imipenem (99.0%), amikacin (98.1%), ertapenem (94.2%), fosfomycin (90.7%), and piperacillin-tazobactam (90.1%). The frequencies of ESBLs among E. coli, K. pneumoniae, and P. mirabilis were 15.2 %, 22.3%, and 8%, respectively. Fosfomycin, piperacillin-tazobactam, and nitrofurantoin were most effective against Gram-positive organisms. Conclusions: Fosfomycin may be an excellent option for cystitis treatment in patients without risk factors, whereas piperacillin-tazobactam is preferred for the treatment of parenchymatous UTIs, complicated UTIs, and UTIs associated with risk factors. To ensure the optimal selection of antibiotics, physicians should have access to up-to-date information about the local prevalence of antimicrobial resistance.

Extended-Spectrum Beta-Lactamase-Producing Bacteria in a Urology Ward: Epidemiology, Risk Factors and Antimicrobial Susceptibility Patterns

2015 ◽  
Vol 95 (3) ◽  
pp. 288-292 ◽  
Author(s):  
Jos� Medina-Polo ◽  
Ana Arr�bola-Pajares ◽  
Santiago P�rez-Cadavid ◽  
Ra�l Ben�tez-Sala ◽  
Raquel Sope�a-Sutil ◽  
...  
Keyword(s):  
Risk Factors ◽  
Antimicrobial Susceptibility ◽  
Beta Lactamase ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum ◽  
Susceptibility Patterns

scholarly journals Risk Factors for and Outcomes Associated with Clinical Isolates ofEscherichia coliandKlebsiellaSpecies Resistant to Extended-Spectrum Cephalosporins among Patients Admitted to Canadian Hospitals

2009 ◽  
Vol 20 (3) ◽  
pp. e43-e48 ◽  
Author(s):  
Marianna Ofner-Agostini ◽  
Andrew Simor ◽  
Michael Mulvey ◽  
Alison McGeer ◽  
Zahir Hirji ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Univariate Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Care Facility ◽  
P Value ◽  
Third Generation ◽  
Multivariate Logistic Regression ◽  
Extended Spectrum ◽  
Third Generation Cephalosporins

BACKGROUND: Clinical features associated with Gram-negative bacterial isolates with extended-spectrum beta-lactamase (ESBL)- and AmpC-mediated resistance identified in Canadian hospitals is largely unknown. The objective of the present study was to determine the demographics, risk factors and outcomes of patients with ESBL- or AmpC-mediated resistant organisms in Canadian hospitals.METHODS: Patients with clinical cultures ofEscherichia coliorKlebsiellaspecies were matched with patients with a similar organism but susceptible to third-generation cephalosporins. Molecular identification of the AmpC or ESBL was determined using a combination of polymerase chain reaction and sequence analysis. Univariate and multivariate logistic regression analysis was performed to identify variables associated with becoming a case.RESULTS: Eight Canadian hospitals identified 106 cases (ESBL/AmpC) and 106 controls. All risk factors identified in the univariate analysis as a predictor of being an ESBL/AmpC cases at the 0.20 P-value were included in the multivariate analysis. No significant differences in outcomes were observed (unfavourable responses 17% versus 15% and mortality rates 13% versus 7%, P not significant). Multivariate logistic regression found an association of becoming an ESBL/AmpC case with: previous admission to a nursing home (OR 8.28, P=0.01) or acute care facility (OR 1.96, P=0.03), length of stay before infection (OR 3.05, P=0.004), and previous use of first-generation cephalosporins (OR 2.38, P=0.02) or third-generation cephalosporins (OR 4.52, P=0.01). Appropriate antibiotics were more likely to be given to controls (27.0% versus 13.3%, P=0.05) and number of days to appropriate antibiotics was longer for cases (median 2.8 days versus 1.2 days, P=0.05).CONCLUSION: The importance of patient medical history, present admission and antibiotic use should be considered for allE coliorKlebsiellaspecies patients pending susceptibility testing results.

scholarly journals Risk Factors, Antimicrobial Susceptibility Patterns and Carbapenem Resistance Mechanisms of Elizabethkingia anophelis Clinical Isolates From a University Tertiary Hospital in Southwest China

2020 ◽  
Author(s):  
Yanbin Chang ◽  
Daiqin Zhang ◽  
Siqiang Niu ◽  
Qian Chen ◽  
Qiuxia Lin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Mortality ◽  
Antimicrobial Susceptibility ◽  
Southwest China ◽  
Carbapenem Resistance ◽  
Tertiary Hospital ◽  
Resistance Mechanisms ◽  
Chronic Obstructive ◽  
Broth Microdilution Method ◽  
Susceptibility Patterns

Abstract Purpose: Elizabethkingia anophelis (E. anophelis) is an important extensively drug-resistant (XDR) pathogen to which there are limited therapeutic options. E. anophelis is perpetually misidentified as Elizabethkingia meningoseptica (E. meningoseptica) by conventional methods. Consequently, this study reassessed risk factors for infection and mortality, antimicrobial susceptibility patterns and carbapenem resistance mechanisms of E. anophelis.Methods: This retrospective case–control study was conducted to reveal the risk factors associated with E. anophelis infection and in-hospital mortality from 2015–2019 in a university tertiary hospital in southwest China using univariable and multivariable logistic-regression analysis. Case patients infected with E. anophelis isolates and controls patients with non-E. anophelis infections were compared at a ratio of 1:3 during the same time period. We employed the broth microdilution method to investigate the antimicrobial susceptibility profiles of 39 E. anophelis strains. PCR amplification, DNA sequencing and gene cloning were used to investigate the mechanisms of carbapenem resistance in E. anophelis.Results: We collected 39 non-repetitive E. anophelis isolates over the study period. Multivariate analysis indicated that coronary artery disease, chronic obstructive pulmonary disease, surgery in the past 6 months, anemia and systemic steroid use were independent risk factors for the acquisition of E. anophelis. Additionally, anemia was the only independent risk factor associated with in-hospital mortality in patients with E. anophelis infections. E. anophelis isolates showed high in-vitro susceptibility towards minocycline (100%) and piperacillin/tazobactam (71.8%), but were resistant to colistin, fosfomycin, ceftazidime/avibactam and aztreonam/avibactam. Additionally, we show that two metallo-β-lactamases (MBLs) BlaB and GOB, are responsible for carbapenem resistance and the serine-β-lactamase, CME, is functionally involved in resistance to cephalosporins and monobactams. Importantly, the various putative efflux pumps in E. anophelis are not responsible for resistance. Conclusion: Our findings will help clinicians identify high-risk patients and suggest that minocycline should be considered as an antibiotic therapeutic option for infections caused by E. anophelis. Additionally, carbapenem resistance in E. anophelis isolates is mainly associated with the MBLs, BlaB and GOB.

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