scholarly journals Epidemiology and risk factors for ESBL-producing Klebsiella pneumoniae: a case control study

2010 ◽  
Vol 4 (11) ◽  
pp. 717-722 ◽  
Author(s):  
Kutbettin Demirdag ◽  
Salih Hosoglu
Keyword(s):  
Risk Factors ◽  
Klebsiella Pneumoniae ◽  
Surgical Intervention ◽  
Univariate Analysis ◽  
Antibiotic Use ◽  
Case Control ◽  
University Hospital ◽  
Stepwise Logistic Regression ◽  
Invasive Infection ◽  
Stepwise Logistic Regression Analysis

Introduction: Increased production of extended-spectrum β-lactamases (ESBLs) has become an important issue for treatment of severe Klebsiella pneumoniae (K. pneumoniae) infections. This study aimed to evaluate risk factors of infection from ESBL-producing K. pneumoniae (ESBL-KP). Methodology: Risk factors were evaluated using a retrospective case control design. Fifty-two patients admitted to Firat University Hospital (FUH) with invasive infections from ESBL-KP were employed as cases. Patients admitted to FUH with non-ESBL-producing K. pneumoniae invasive infection were chosen as controls. Potential risk factors of the cases and controls were evaluated using hospital charts. Pulsed-field Gel Electrophoresis (PFGE) was used to show the relatedness of ESBL-KP strains. Results: In univariate analysis, the following factors were found significant for ESBL-KP: pre-infection hospital stay, nosocomial origin, central venous catheterization, surgical intervention, antibiotic use longer than one week, and previous hospitalization. In contrast, stepwise logistic regression analysis showed that two variables, previous antibiotic use (p = 0.000) and surgical intervention (p = 0.006), remained significantly associated with risk for infection with an ESBL-KP. Molecular epidemiology identified several clusters among the ESBL-producing isolates. Conclusions: Antibiotic use and surgical intervention were significant associated factors for infections with ESBL-KP.

scholarly journals The Prevalence of Health Care-Associated Infections and Risk Factors in a University Hospital

Medicina ◽  
2012 ◽  
Vol 48 (8) ◽  
pp. 59 ◽  
Author(s):  
Greta Gailienė ◽  
Zita Gierasimovič ◽  
Daiva Petruševičienė ◽  
Aušra Macijauskienė
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Acute Care ◽  
Prevalence Rate ◽  
Antimicrobial Agents ◽  
Univariate Analysis ◽  
University Hospital ◽  
Stepwise Logistic Regression ◽  
Antimicrobial Use ◽  
Health Care Associated Infections

The aim of the study was to evaluate the prevalence of health care-associated infections, risk factors, and antimicrobial use. Material and Methods. The study was carried out as a point-prevalence study in acute care wards, i.e., intensive care, surgical, and medical wards, at Vilnius University Hospital Santariškių Klinikos in April 2010. The study variables included the patient’s general data, indwelling devices, surgery, infection and its microbiological investigation, and antimicrobial use. All the variables that were logically related or had a P value of <0.25 in the univariate analysis were included in the stepwise logistic regression in order to study the factors potentially associated with health careassociated infections. Results. A total of 731 patients were surveyed. The overall prevalence rate of health care-associated infections was 3.8%. The prevalence of health care-associated infections differed by hospital wards (range 0.0%–19.2%). The lower respiratory tract (32.2%), urinary tract (28.5%), and surgical site infections (32.1%) were the most common health care-associated infections. Moreover, 89.3% of the cases of health care-associated infections were microbiologically investigated. Staphylococcus aureus (28.6%) and Escherichia coli (19.1%) were the most frequently isolated microorganisms. The use of one or more invasive devices was recorded in 332 patients (45.4%). Of the surveyed patients, 20.2% received antimicrobial agents. The most commonly prescribed antimicrobial agents were fluoroquinolones (21.1%), broad-spectrum penicillins (19.1%), and first- or second-generation cephalosporins (18.6%). Conclusions. The prevalence of health care-associated infections was found to be similar to the reported overall prevalence rate of health care-associated infections in acute care hospitals in Lithuania.

scholarly journals Severe acquired subglottic stenosis in neonatal intensive care graduates: a case–control study

2017 ◽  
Vol 103 (4) ◽  
pp. F349-F354 ◽  
Author(s):  
Rebecca E Thomas ◽  
Shripada C Rao ◽  
Corrado Minutillo ◽  
Shyan Vijayasekaran ◽  
Elizabeth A Nathan
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Case Control Study ◽  
Surgical Intervention ◽  
Conditional Logistic Regression ◽  
Univariate Analysis ◽  
Case Control ◽  
Subglottic Stenosis ◽  
Control Study

ObjectiveTo analyse current incidence and risk factors associated with severe acquired subglottic stenosis (SASGS) requiring surgical intervention in neonates.DesignRetrospective case–control study.SettingSole tertiary children’s hospital.ParticipantsPatients who underwent surgical intervention for SASGS from January 2006 to December 2014. For each neonatal intensive care unit (NICU) graduate with acquired SASGS, two controls were selected (matched for gestation and year of birth).Main outcomes and measuresIncidences were calculated and cases and controls compared using conditional logistic regression analysis to identify risk factors for SASGS.ResultsThirty-seven NICU graduates required surgical intervention for SASGS of whom 35 were <30-week gestation at birth. The incidence of SASGS in surviving children who had required ventilation in the neonatal period was 27/2913 (0.93%). Incidence was higher in infants <28-week gestation (24/623=3.8%) compared with infants ≥28-week gestation (3/2290=0.13%; p=0.0001). On univariate analysis, risk factors for SASGS were: higher number of intubations (4 vs 2; p<0.001); longer duration ventilation (16 vs 9.5 days; p<0.001); unplanned extubation (45.7% vs 20.0%; p=0.007); traumatic intubation (34.3% vs 7.1%; p=0.003) and oversized endotracheal tubes (ETTs) (74.3% vs 42.9%; p=0.001). On multivariate analysis, risk factors for SASGS were: Sherman ratio >0.1 (adjusted OR (aOR) 6.40; 95% CI 1.65 to 24.77); more than five previous intubations (aOR 3.74; 95% CI 1.15 to 12.19); traumatic intubation (aOR 3.37; 95% CI 1.01 to 11.26).ConclusionsSASGS is a serious consequence of intubation for mechanical ventilation in NICU graduates, especially in preterm infants. Minimising trauma during intubations, avoiding recurrent extubation/reintubations and using appropriate sized ETTs may help prevent this serious complication.

Risk Factors for Nosocomial Bacteremia in a Large Spanish Teaching Hospital: A Case-Control Study

1991 ◽  
Vol 12 (3) ◽  
pp. 150-156 ◽  
Author(s):  
Antoni Trilla ◽  
Josep M. Gatell ◽  
Josep Mensa ◽  
Xavier Latorre ◽  
Manuel Almela ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Strong Support ◽  
Case Control ◽  
Control Measures ◽  
University Hospital ◽  
Stepwise Logistic Regression ◽  
Infection Control Measures ◽  
Nosocomial Bacteremia ◽  
Control Study

AbstractObjective:Identify independent risk factors associated with the development of nosocomial bacteremia.Design:Exploratory, unmatched, case-control study.Setting:A 970-bed Spanish university hospital.Patients:All non-neutropenic adult patients with nosocomial bacteremia admitted during a 12-month period were eligible as cases. All adult non-neutropenic patients without nosocomial bacteremia were eligible as controls.Results:The incidence of bacteremia in the study population was 6.9/1000 admissions/ year. One hundred eighty cases and 180 controls were analyzed. Multivariate analysis (stepwise logistic regression techniques) identified seven risk factors independently associated with nosocomial bacteremia: age above 65 years; prior admission (within six months) to the hospital; underlying diseases that were ultimately or rapidly fatal; indwelling urethral catheter in place for more than three days; intravenous central lines or peripheral venous lines (if in place for more than four days); “high-risk surgery” (i.e., lower abdominal, cardiac or thoracic); and admission to an intensive care unit.Conclusions:Although five variables are not modifiable, the remaining two relate to the use and duration of devices. Our data give strong support for the value of testing strict guidelines for limiting vascular catheters and evaluating the need for prolonged urethral catheterization. If effective infection control measures are identified, we could target hospital-wide surveillance to patients whose risk factors are amenable to intervention.

The Use of Total Contact Orthoses in Patients with Foot Problems in Foot Clinic, Siriraj Hospital

2020 ◽  
Vol 103 (12) ◽  
pp. 1292-1299
Keyword(s):  
Odds Ratio ◽  
Univariate Analysis ◽  
Stepwise Logistic Regression ◽  
Posterior Tibial Tendon ◽  
Posterior Tibial Tendon Dysfunction ◽  
Stepwise Logistic Regression Analysis ◽  
Cross Sectional ◽  
Siriraj Hospital ◽  
Foot Problems ◽  
Foot Clinic

Objective: To study the use rate, outcome, and concomitant factors of the use of the total contact orthoses (TCO) in the Foot Clinic, Siriraj Hospital Materials and Methods: The present study was a cross-sectional descriptive study collecting data from patient medical records and questionnaires. Patients who had foot problems without impairment of foot sensation and received the TCO from the Foot Clinic between July 2015 and April 2016 were interviewed before and after using the latest TCO for one month. Results: One hundred seven participants were recruited. Most were female (84.1%) with a median age of 59.3 years. The majority had chronic plantar fasciitis (26.2%), posterior tibial tendon dysfunction (PTTD) (25.2%), hallux valgus (21.5%), or metatarsalgia (21.5%). The TCO user was defined as a participant who had to use the TCO for more than three days per week and for more or equal to 50% of daily walking and standing duration. The use rate was 67.3%. The TCO provides standing and walking stability (p=0.008). For patients with metatarsalgia, using the TCO could significantly reduce pain (p=0.002). Using univariate analysis, many factors were found to be associated with the use of the TCO including having level of convenience of putting on or taking off shoes with TCO at 9 or more (odds ratio 2.66, 95% CI 1.16 to 6.12), having difficulty to find proper shoes that fit with the TCO (odds ratio 0.36, 95% CI 0.15 to 0.89), receiving more than one pair of TCO (odds ratio 4.09, 95% CI 1.51 to 11.05), and having level of comfort satisfaction during the TCO use at 9 or more (odds ratio 3.61, 95% CI 1.55 to 8.40). The latter two factors were found to be associated with the use of the TCO from stepwise logistic regression analysis (adjusted odds ratio 3.39, 95% CI 1.18 to 9.71 and 3.02, 95% CI 1.07 to 8.47, respectively). Conclusion: The use of the TCO in the Foot Clinic, Siriraj Hospital was 67.3%. Using the TCO could promote walking stability. Factors affecting the use of the TCO included receiving more than the first pair of TCO and having comfort satisfaction level of 9 or more. Keywords: Use, Total contact orthoses, Total contact insole, Foot problems

scholarly journals Risk factors for suicidal tendency in people with epilepsy in China: a case–control study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mintao Lin ◽  
Jiani Chen ◽  
Sisi Li ◽  
Yingjie Qin ◽  
Xuruan Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Low Income ◽  
Case Control Study ◽  
Univariate Analysis ◽  
Case Control ◽  
Conditional Inference ◽  
Suicidal Tendency ◽  
Patients With Epilepsy ◽  
Nested Case Control ◽  
Control Study

AbstractPeople with epilepsy (PWE) have an increased suicide prevalence. This study aimed to identify the risk factors for suicidal tendency among PWE in West China. A nested case–control study was designed in a cohort of patients with epilepsy (n = 2087). In total, 28 variates were calculated. In the univariate analysis, unemployment, low income, seizure frequency, seizure-free time, infectious or structural etiology, levetiracetam or phenobarbital use, anxiety, depression, and stigma were associated with suicidal tendency. A multivariate analysis indicated that unemployment (odds ratio [OR] 5.74, 95% confidence interval [CI] 2.13–15.48), levetiracetam use (OR 2.80, 95%CI 1.11–7.05), depression (C-NDDI-E score ≥ 13; OR 3.21, 95%CI 1.26–8.21), and stigma (SSCI score ≥ 16; OR 6.67, 95%CI 1.80–24.69) were independently associated with suicidal tendency. Conditional inference tree analysis indicated that SSCI and C-NDDI-E scores could effectively identify patients with suicidal tendency. Thus, this study suggests that unemployment, levetiracetam use, depression, and stigma are independent risk factors for suicidal tendency in PWE in China.

scholarly journals 832. Assessment of Risk Factors Associated with Wide-resistance Gram-negative Bacteria Infections

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S457-S457
Author(s):  
Henry Pablo Lopes Campos e Reis ◽  
Ana Beatriz Ferreira Rodrigues ◽  
Julio César Castro Silva ◽  
Lia Pinheiro de Lima ◽  
Talita Lima Quinaher ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Univariate Analysis ◽  
Multidrug Resistant ◽  
University Hospital ◽  
Gram Negative Bacteria ◽  
Multiresistant Pathogens ◽  
Gram Negative ◽  
Contact Isolation ◽  
Bladder Catheter

Abstract Background Enterobacteria and multidrug-resistant non-fermenting Gram-negative bacilli present a challenge in the management of invasive infections, leading to mortality rates due to their limited therapeutic arsenal. The objective of this work was to analyze risk factors that may be associated with these infections, for a better situational mapping and assertive decision-making in a university hospital in Brazil. Methods The study was conducted between January and September 2019, with 167 patients in contact isolation at a university hospital in Brazil. Potential outcome-related variables for wide-resistance Gram-negative bacteria (BGN) infections were evaluated. Risk factors were identified from univariate statistical analysis using Fisher’s test. Results 51 (30.5%) out of 167 patients in contact isolation evolved with wide-resistance BGN infection. Risk factors in univariate analysis were age, hospital unit and previous use of invasive devices. Patients aged up to 59 years were more likely to progress to infection than those aged over 60 years (p 0.0274, OR 2.2, 95% CI 1.1-4.5). Those admitted to the oncohematology (p &lt; 0.001, OR 32.5, Cl 9.1-116.3) and intensive care unit (p &lt; 0.001, OR 28.0, Cl 3.5-225.9) units were more likely to develop this type of infection. The least likely were those admitted to a kidney transplant unit (p 0.0034, OR 15.33, Cl 1.8-131.0). Prior use of mechanical ventilation (p 0.0058, OR 12.2, Cl 2.0-76.1) and delayed bladder catheter (p 0.0266, OR 5.0, Cl 1.2-20.1) in patients with respiratory and urinary tract infection, respectively, were also reported as risk factors related to these infections. The gender of the patients was not significant for the study. Conclusion This study determined that variables such as age, hospitalization unit, use of mechanical ventilation and delayed bladder catheter could be considered important risk factors in triggering the infectious process by wide-resistant gram-negative bacteria. Thus, the analysis of these factors becomes a great foundation to prevent the development of multiresistant pathogens through prevention strategies, prophylaxis management and more targeted empirical therapies. Disclosures All Authors: No reported disclosures

scholarly journals Established the first clinical prediction model regarding the risk of hyperuricemia in IgA nephropathy

2021 ◽  
Author(s):  
Yin-Hong Geng ◽  
Zhe Zhang ◽  
Jun-Jun Zhang ◽  
Bo Huang ◽  
Zui-Shuang Guo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Iga Nephropathy ◽  
Interstitial Fibrosis ◽  
Characteristic Curve ◽  
Univariate Analysis ◽  
Curve Analysis ◽  
University Hospital ◽  
Prediction Ability ◽  
Decision Curve Analysis ◽  
Incidence Risk

Abstract Objective. To construct a novel nomogram model that predicts the risk of hyperuricemia incidence in IgA nephropathy (IgAN) . Methods. Demographic and clinicopathological characteristics of 1184 IgAN patients in the First Affiliated Hospital of Zhengzhou University Hospital were collected. Univariate analysis and multivariate logistic regression were used to screen out hyperuricemia risk factors. The risk factors were used to establish a predictive nomogram model. The performance of the nomogram model was evaluated using an area under the receiver operating characteristic curve (AUC), calibration plots, and a decision curve analysis. Results. Independent predictors for hyperuricemia incidence risk included sex, hypoalbuminemia, hypertriglyceridemia, blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), 24-hour urinaryprotein (24h TP), Gross and tubular atrophy/interstitial fibrosis (T). The nomogram model exhibited moderate prediction ability with an AUC of 0.834 ((95% CI 0.804–0.864)). The AUC from validation reached 0.787 (95% CI 0.736-0.839). The decision curve analysis displayed that the hyperuricemia risk nomogram was clinically applicable.Conclusion. Our novel and simple nomogram containing 8 factors may be useful in predicting hyperuricemia incidence risk in IgAN.

scholarly journals Gastrointestinal carriage of Klebsiella pneumoniae in a general adult population in Norway: a cross-sectional study of risk factors and bacterial genomic diversity

2021 ◽  
Author(s):  
Niclas Raffelsberger ◽  
Marit Andrea Klokkhammer Hetland ◽  
Kristian Svendsen ◽  
Lars Småbrekke ◽  
Iren H. Löhr ◽  
...  
Keyword(s):  
Risk Factors ◽  
Population Structure ◽  
General Population ◽  
Klebsiella Pneumoniae ◽  
Representative Sample ◽  
Adult Population ◽  
Antibiotic Use ◽  
Genomic Diversity ◽  
Prescription Database ◽  
Hospitalised Patients

SummaryBackgroundKlebsiella pneumoniae is a leading public health threat due to its increasing prevalence of antibiotic resistance. Gastrointestinal carriage of K. pneumoniae is a risk factor for subsequent infections in hospitalised patients. We determined risk factors for gastrointestinal carriage and the genomic population structure of K. pneumoniae colonising humans in a representative sample of a general population.Methods2,975 individuals (54% women) ≥40y participating in the population-based Tromsø Study 7 (2015-2016) were included. Faecal samples were screened for K. pneumoniae which were characterised using whole-genome sequencing. Risk factors for carriage were analysed using data from the Norwegian Prescription Database and questionnaires, using multivariable logistic regression.FindingsPrevalence of K. pneumoniae gastrointestinal carriage was 16·3% (95% CI 15·0-17·7%) with no gender difference. Risk factors associated with carriage included age ≥60y, travel to Greece or Asia past 12 months (adjusted odds ratio 1·49, 95% CI 1·11-2·00), Crohn’s disease/ulcerative colitis (2·26, 1·20-4·27), use of protein pump inhibitors (1·62, 1·18-2·22) and non-steroidal anti-inflammatory drugs past six months (1·38, 1·04-1·84), and antibiotic use last month (1·73, 1·05-2·86). Prevalence was higher among those having used combinations of drug classes and decreased over time with respect to preceding antibiotic use. The K. pneumoniae population was diverse with 300 sequence types among 484 isolates distributed across four phylogroups. Among the isolates, 5·2% and 11·6% harboured acquired resistance and virulence factors, respectively.InterpretationIdentification of risk factors for gastrointestinal carriage in a representative sample of a general population allows for identification of individuals that may have a higher risk of extraintestinal infection during hospitalisation. The diverse population structure of K. pneumoniae carriage isolates reflects the ecologically adaptive capacity of the bacterium, and the low antibacterial consumption probably contributes to the low prevalence of resistance in clinical isolates in Norway.

scholarly journals Allogeneic Red Blood Cell Transfusion Rate and Risk Factors in Elderly Patients With Femoral Neck Fracture After Hemiarthroplasty

2020 ◽  
Author(s):  
Rui Yue ◽  
Minghui Yang ◽  
Xiaohui Deng ◽  
Ping Zhang
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Regression Analysis ◽  
Femoral Neck ◽  
Elderly Patients ◽  
Blood Cell ◽  
Stepwise Logistic Regression ◽  
Stepwise Logistic Regression Analysis ◽  
Neck Fracture ◽  
Multivariate Stepwise Logistic Regression

Abstract Objective: To determine the rate and risk factors of allogeneic red blood cell transfusions (ABT) in elderly patients with femoral neck fracture (FNF) after hemiarthroplasty (HA). Methods: We conducted a study on elderly patients (≥65 years old) who were admitted to the geriatric trauma orthopedics ward of Beijing Jishuitan Hospital for HA treatment from March 2018 to February 2019 due to FNF. The perioperative data were collected retrospectively, and univariate and multivariate stepwise logistic regression analysis were performed to determine the postoperative ABT rate and its risk factors. Results: 343 patients were included in the study, of which 151 (44.0%) received ABT after surgery. Multivariate stepwise logistic regression analysis showed that preoperative low hemoglobin (Hb), high intraoperative blood loss (IBL), advanced age, and low body mass index (BMI) are independent risk factors of ABT after HA in elderly FNF patients. Conclusion: ABT after HA is a common phenomenon in elderly patients with FNF. Their postoperative ABT needs are related to preoperative low Hb, high IBL, advanced age, and low BMI. Therefore, ABT can be reduced from the above aspects.

scholarly journals Vancomycin-resistance Enterococcal Colonization in Hospitalized Patients in Relation to Antibiotic Usage in a Tertiary Care Hospital of North India

2015 ◽  
Vol 7 (02) ◽  
pp. 108-111 ◽  
Author(s):  
Tuhina Banerjee ◽  
Shampa Anupurba ◽  
Joel Filgona ◽  
Dinesh K Singh
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Tertiary Care ◽  
Significant Risk ◽  
Antibiotic Use ◽  
Antibiotic Usage ◽  
Hospitalized Patients ◽  
University Hospital ◽  
North India ◽  
Care Hospital

ABSTRACT Background: Alarming rise of vancomycin-resistant enterococci (VRE) is a global cause of concern. Several factors have been held responsible for such rise, of which antibiotic usage is a prominent one. Objectives: This study was undertaken to determine the intestinal VRE colonization rate amongst hospitalized patients in relation to use of various antibiotics in the Intensive Care Unit (ICU) of a tertiary care university hospital, India. Materials and Methods: Stool samples were collected weekly from all the patients in the adult ICU for a period of 6 months and processed for isolation and phenotypic and genotypic characterization of VRE isolates. Patient and treatment details were noted and cases (those with VRE in stool) and controls (those without VRE in stool) were compared statistically. Further, a multivariate analysis was done to identify those antibiotics as independent risk factors for VRE colonization. Results: VRE colonization was found in 34.56% (28/81) of the patients studied, with the majority 75% (21/28) carrying the vanA gene. The cases had significantly more (P < 0.05) duration of hospital stay and antibiotic exposure. Intake of metronidazole, vancomycin, and piperacillin-tazobactam were identified as significant risk factors both in univariate and multivariate analysis. Conclusion: A potential reservoir of VRE was thus revealed even in low VRE prevalence setting. Based on this high colonization status, restriction of empirical antibiotic use, reviewing of the ongoing antibiotic policy, and active VRE surveillance as an integral part of infection control strategy were suggested.

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