scholarly journals Hospital-acquired pneumonia due to Achromobacter xylosoxidans in the elderly: A single-center retrospective study in Beijing

2017 ◽  
Vol 11 (01) ◽  
pp. 10-18 ◽  
Author(s):  
Chao Liu ◽  
Jun Guo ◽  
Weifeng Yan ◽  
Yi Jin ◽  
Fei Pan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Clinical Manifestations ◽  
The Elderly ◽  
Achromobacter Xylosoxidans ◽  
Apache Ii Score ◽  
Chronic Obstructive ◽  
Indwelling Catheter ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Introduction: Achromobacter xylosoxidans has been reported in several countries; however, hospital-acquired pneumonia (HAP) due to this organism in elderly patients in China remains rare. Methodology: HAP due to Achromobacter xylosoxidans identified at the General Hospital of the People's Liberation Army in Beijing from January 2008 to October 2011 was studied. Detailed clinical manifestations were collected. To study the clinical risk factors for the imipenem-resistant strain, patients were divided into two groups: imipenem-resistant (21 cases) and imipenem-nonresistant (20 cases). Univariate and multivariate logistic regression were used. Results: All patients were > 75 years of age, and 92.7% (38/41) were male. Nine patients died 30 days after infection. The mean acute physiology and chronic health evaluation (APACHE) II score and sequential organ failure assessment (SOFA) were 23.66 ± 7.71 and 6.93 ± 2.47, respectively. Almost all strains were resistant to aminoglycosides. However, the strains showed significant sensitivity to minocycline (MIN), piperacillin-tazobactam (PTZ), and cefoperazone-sulbactam (SCF). Compared with the imipenem-nonresistant group, more patients with imipenem-resistant infection had the following characteristics: use of an intubation, use of a proton-pump inhibitor (PPI), chronic obstructive pulmonary disease (COPD), and coronary artery disease (CHD). Among the four risk factors, COPD and CHD remained independent risk factors in the multivariate analysis. Conclusions: HAP due to Achromobacter xylosoxidans occurred in severely ill elderly patients with a long-term indwelling catheter and many underlying diseases. Effective treatment of imipenem-resistant organisms is challenging. SCF, PTZ, and MIN may be useful for imipenem-resistant Achromobacter xylosoxidans.

scholarly journals Clinical Characteristics in Patients with Hospital-Acquired Pneumonia Caused by Extensively Drug-Resistant Acinetobacter baumannii, A Multicenter Retrospective Study

2020 ◽  
Author(s):  
Yujun Li ◽  
Xiaomei Huang ◽  
Yuyao Wang ◽  
Chuzhi Pan ◽  
Zexun Mo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Drug Resistant ◽  
Central Venous ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired ◽  
Lactamase Inhibitor

Abstract Background Extremely drug-resistant (XDR) Acinetobacter baumannii （A. baumannii）has been of a great concern. The relationship between XDR and patient outcomes remains unclear. We investigated the clinical features, risk factors, and outcomes of Hospital-acquired pneumonia (HAP)caused by XDR A. baumannii. Methods A multicenter retrospective case-control study was performed to determine factors associated with XDR A. baumannii pneumonia from 5 teaching hospitals in Guangzhou, China. Results 76 patients were enrolled in the study. XDR A. baumannii pneumonia patients were tend to be smoker (11.9% vs 3.9%, P = 0.130) and older (76.5±11.2 vs 70.3±16.4, P = 0.007) and had more comorbid diseases including chronic obstructive pulmonary disease (COPD) (48.7% vs 21.1%, P = 0.001) and renal failure (21.1% vs 3.9%, P = 0.002) and had higher APACHE II score (65.8% vs 47.4%, P = 0.033). Invasive procedures including insertion of urinary catheter, nasogastric tube, central venous/arterial catheter, bronchoscopy and mechanical ventilation along with using β-lactam/β-lactamase inhibitor and carbapenem were also risk factors for XDR A. baumannii pneumonia. Multivariate analysis showed the APACHE II score >=20 (OR, 2.1; 95% CI: 1.1–4.1, P = 0.023), COPD (OR, 9.6; 95% CI: 2.0–45.5, P = 0.004), central venous/arterial catheter placement (OR,11.5; 95% CI: 1.1-117.8, P = 0.040), low albumin levels (OR, 1.2; 95% CI: 1.1-1.4, P = 0.001) and using β-lactam/β-lactamase inhibitor (OR,15.9; 95% CI: 2.7-94.2, P = 0.002) were independent risk factors for XDR A. baumannii pneumonia. Compared with the non-XDR A. baumannii patients, the XDR A. baumannii pneumonia increased length of mechanical ventilation (11.1±12.3 vs 5.1±5.6, P = 0.000), hospital stay (42.2±24.3 vs 34.8±18.0, P = 0.036) and ICU (Intensive Care Unit) stay (27.5±19.0 vs 20.0±20.5, P = 0.020), but it did not increase in-hospital mortality (47.4% vs 32.9%, P = 0.137). Conclusions XDR A. baumannii pneumonia was strongly related to systemic illnesses, invasive procedure, low albumin levels and the APACHE II score and increasing the length of mechanical ventilation and hospital stay. But it did not increase in-hospital mortality.

scholarly journals Influencing Factors of Hospital-Acquired Pneumonia Infection in the Middle-Aged and Elderly Patients With Schizophrenia

2021 ◽  
Vol 12 ◽  
Author(s):  
Mi Yang ◽  
Qiwen Li ◽  
Chunzhi Wang ◽  
Li Li ◽  
Min Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Elderly Patients ◽  
Infection Rate ◽  
Large Scale ◽  
Antipsychotic Drugs ◽  
Personal Characteristics ◽  
Middle Aged ◽  
Chi Square ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

Introduction: Pneumonia is an important cause of death in patients with schizophrenia. It is critical to understand the risk factors of hospital-acquired pneumonia (HAP) and determine prevention strategies to reduce HAP. The aim of this study is to elucidate the risk factors for HAP in the middle-aged and elderly hospitalized patients with schizophrenia.Methods: We retrospectively reviewed the medical records of 2,617 the middle-aged and elderly patients (age ≥ 50) with schizophrenia who were admitted for the first time to a large-scale psychiatric hospital between 2016 and 2020. The factors related to the incidence of HAP in patients were analyzed, including personal characteristics, antipsychotics, and non-antipsychotics.Results: The HAP infection rate of hospitalized the middle-aged and elderly patients with schizophrenia was 7.8%. Chi-square analyses showed that older age, male, and ≥60 days of hospitalization were risk factors for HAP infection (χ2 = 94.272, p < 0.001; χ2 = 22.110, p < 0.001; χ2 = 8.402, p = 0.004). Multivariate logistic regression showed that quetiapine, clozapine, and olanzapine significantly increased the incidence of HAP (OR = 1.56, 95% CI = 1.05–2.32, p = 0.029; OR = 1.81, 95% CI = 1.26–2.60, p = 0.001; OR = 1.68, 95% CI = 1.16–2.42, p = 0.006). Antipsychotic drugs combined with aceglutamide had an effect on HAP (OR = 2.19, 95% CI = 1.38–3.47, p = 0.001).Conclusion: The high HAP infection rate in hospitalized the middle-aged and elderly patients with schizophrenia may be related to the increase of age and the use of antipsychotic drugs. The types and dosages of antipsychotic drugs should be minimized while paying attention to the mental symptoms of patients.

Hospital Acquired Pneumonia

2016 ◽  
Author(s):  
Joshua Lupton
Keyword(s):  
The Elderly ◽  
Chronic Obstructive ◽  
Microbial Infection ◽  
Term Care ◽  
Obstructive Pulmonary Disease ◽  
Increased Risk ◽  
History Of ◽  
Hospital Acquired Pneumonia ◽  
Pulmonary Parenchyma ◽  
Hospital Acquired

Pneumonia consists of inflammation of the pulmonary parenchyma, typically resulting from a microbial infection. Hospital-acquired pneumonia (HAP) occurs in (typically elderly) patients in long-term care facilities, with regular IV therapy, with immunosuppression, or with a history of recent treatment at a hospital. It is associated with high mortality. The majority HAP patients present with some constellation of cough, fever, sputum production, and pleuritic chest pain. Patients with chronic obstructive pulmonary disease (COPD) and cystic fibrosis are at increased risk for pneumonia. The Infectious Disease Society of America requires infiltrates on chest x-ray or other imaging for the diagnosis of pneumonia. For hospitalized patients, empiric antimicrobial therapy for HAP should be given as soon as pneumonia is highly suspected. There is currently a vaccine available against Streptococcus pneumonia that all patients should be offered before discharge from the hospital. The elderly are already more susceptible to HAP due to decreased mobility and increased comorbidities.

scholarly journals Clinical Analysis of Hospital-acquired Bloodstream Infection in the Elderly

2019 ◽  
Vol 1 (01) ◽  
Author(s):  
Baojun Sun
Keyword(s):  
Risk Factors ◽  
Renal Insufficiency ◽  
Elderly Patients ◽  
Bloodstream Infection ◽  
Sofa Score ◽  
Chronic Renal Insufficiency ◽  
Bloodstream Infections ◽  
The Elderly ◽  
Independent Risk Factors ◽  
Hospital Acquired

Objective: This study was designed to get epidemiological characteristics, etiology characteristics, prognosis assessment and prognostic factors of hospital-acquired bloodstream infection (HABSI) in the elderly in Chinese PLA General Hospital and aimed at providing a reference for HABSI in the elderly on clinical diagnosis and treatment to improve the prognosis. Methods: The clinical data and pathology data of 210 cases of the elderly patients with HABSI from 2009 to 2012 in geriatric wards were retrospectively analyzed. Compare the clinical assessment effects of APACHE-II score, SAPS-II score and SOFA score to HABSI prognosis in the elderly by plotting the receiver operating characteristic curve. Use univariate and multivariate logistic regression analysis to get prognostic factors of HABSI in the elderly. Results: Univariate analysis of mortality: Day 1 apache -> 18 II score, lung infection, invasive ventilation, chronic hepatic insufficiency, chronic renal insufficiency, substantive organ malignant tumor, deep venipuncture, indwelling gastric tube indwelling ureter, complicated with shock and acquired bloodstream infections in the elderly patients with 7 days survival state association is significant. Day-1 SOFA score>7, chronic liver dysfunction, chronic renal insufficiency, concurrent shock, hemodialysis and 28-day survival status of patients with acquired bloodstream infection in elderly hospitals were significantly associated. Multivariate unconditioned logistic regression analysis related to death: Day-1APACHE-II score>18, parenchymal malignant tumors, and concurrent shock are independent risk factors for 7-day death in elderly patients with acquired bloodstream infection. Day-1 SOFA score>7, chronic renal insufficiency, and concurrent shock are independent risk factors for 28-day mortality in elderly patients with acquired bloodstream infection. Conclusion: The incidence of acquired bloodstream infections in the elderly was 1.37%. The 7-day and 28-day mortality rates were 8.10% and 22.38%, respectively. Concurrent shock is 26.7%. The 28-day mortality rate of concurrent shock patients was 48.21%. The best outcome score for the 7-day prognosis of elderly patients with acquired bloodstream infection was the Day-1APACHE-II score, followed by the Day-1 SOFA score. The best score for the 28-day prognostic assessment was the Day-1 SOFA score.

scholarly journals Clinical Analysis of Hospital-acquired Bloodstream Infection in the Elderly

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Baojun Sun
Keyword(s):  
Risk Factors ◽  
Renal Insufficiency ◽  
Elderly Patients ◽  
Bloodstream Infection ◽  
Sofa Score ◽  
Chronic Renal Insufficiency ◽  
Bloodstream Infections ◽  
The Elderly ◽  
Independent Risk Factors ◽  
Hospital Acquired

Objective: This study was designed to get epidemiological characteristics, etiology characteristics, prognosis assessment and prognostic factors of hospital-acquired bloodstream infection (HABSI) in the elderly in Chinese PLA General Hospital and aimed at providing a reference for HABSI in the elderly on clinical diagnosis and treatment to improve the prognosis. Methods: The clinical data and pathology data of 210 cases of the elderly patients with HABSI from 2009 to 2012 in geriatric wards were retrospectively analyzed. Compare the clinical assessment effects of APACHE-II score, SAPS-II score and SOFA score to HABSI prognosis in the elderly by plotting the receiver operating characteristic curve. Use univariate and multivariate logistic regression analysis to get prognostic factors of HABSI in the elderly. Results: Univariate analysis of mortality: Day 1 apache -> 18 II score, lung infection, invasive ventilation, chronic hepatic insufficiency, chronic renal insufficiency, substantive organ malignant tumor, deep venipuncture, indwelling gastric tube indwelling ureter, complicated with shock and acquired bloodstream infections in the elderly patients with 7 days survival state association is significant. Day-1 SOFA score>7, chronic liver dysfunction, chronic renal insufficiency, concurrent shock, hemodialysis and 28-day survival status of patients with acquired bloodstream infection in elderly hospitals were significantly associated. Multivariate unconditioned logistic regression analysis related to death: Day-1APACHE-II score>18, parenchymal malignant tumors, and concurrent shock are independent risk factors for 7-day death in elderly patients with acquired bloodstream infection. Day-1 SOFA score>7, chronic renal insufficiency, and concurrent shock are independent risk factors for 28-day mortality in elderly patients with acquired bloodstream infection. Conclusion: The incidence of acquired bloodstream infections in the elderly was 1.37%. The 7-day and 28-day mortality rates were 8.10% and 22.38%, respectively. Concurrent shock is 26.7%. The 28-day mortality rate of concurrent shock patients was 48.21%. The best outcome score for the 7-day prognosis of elderly patients with acquired bloodstream infection was the Day-1APACHE-II score, followed by the Day-1 SOFA score. The best score for the 28-day prognostic assessment was the Day-1 SOFA score.

scholarly journals Clinical Characteristics in Patients With Hospital-acquired Pneumonia Caused by Extensively Drug-resistant Acinetobacter Baumannii, a Multicenter Retrospective Study

2021 ◽  
Author(s):  
Yujun Li ◽  
Xiaomei Huang ◽  
Yuyao Wang ◽  
Chuzhi Pan ◽  
Zexun Mo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Hospital Mortality ◽  
Apache Ii ◽  
Apache Ii Score ◽  
Drug Resistant ◽  
Central Venous ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired ◽  
Lactamase Inhibitor

Abstract Background Extremely drug-resistant （XDR） Acinetobacter baumannii （A. baumannii）has been of a great concern. The relationship between XDR and patient outcomes remains unclear. We investigated the clinical features, risk factors, and outcomes of Hospital-acquired pneumonia (HAP)caused by XDR A. baumannii. Methods A multicenter retrospective case-control study was performed to determine factors associated with XDR A. baumannii pneumonia from 5 teaching hospitals in Guangzhou, China. Results 76 patients were enrolled in the study. XDR A. baumannii pneumonia patients were tend to be smoker (11.9% vs 3.9%, P = 0.130) and older (76.5±11.2 vs 70.3±16.4, P = 0.007) and had more comorbid diseases including chronic obstructive pulmonary disease (COPD) (48.7% vs 21.1%, P = 0.001) and renal failure (21.1% vs 3.9%, P = 0.002) and had higher APACHE II score (65.8% vs 47.4%, P = 0.033). Invasive procedures including insertion of urinary catheter, nasogastric tube, central venous/arterial catheter, bronchoscopy and mechanical ventilation along with using β-lactam/β-lactamase inhibitor and carbapenem were also risk factors for XDR A. baumannii pneumonia. Multivariate analysis showed the APACHE II score >=20 (OR, 2.1; 95% CI: 1.1–4.1, P = 0.023), COPD (OR, 9.6; 95% CI: 2.0–45.5, P = 0.004), central venous/arterial catheter placement (OR,11.5; 95% CI: 1.1-117.8, P = 0.040), low albumin levels (OR, 1.2; 95% CI: 1.1-1.4, P = 0.001) and using β-lactam/β-lactamase inhibitor (OR,15.9; 95% CI: 2.7-94.2, P = 0.002) were independent risk factors for XDR A. baumannii pneumonia. Compared with the non-XDR A. baumannii patients, the XDR A. baumannii pneumonia increased length of mechanical ventilation (11.1±12.3 vs 5.1±5.6, P = 0.000), hospital stay (42.2±24.3 vs 34.8±18.0, P = 0.036) and ICU (Intensive Care Unit) stay (27.5±19.0 vs 20.0±20.5, P = 0.020), but it did not increase in-hospital mortality (47.4% vs 32.9%, P = 0.137). Conclusions XDR A. baumannii pneumonia was strongly related to systemic illnesses, invasive procedure, low albumin levels and the APACHE II score and increasing the length of mechanical ventilation and hospital stay. But it did not increase in-hospital mortality.

scholarly journals Liver Cirrhosis and Diabetes Mellitus Are Risk Factors forStaphylococcus aureusInfection in Patients with Healthcare-Associated or Hospital-Acquired Pneumonia

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Huang-Pin Wu ◽  
Chien-Ming Chu ◽  
Chun-Yao Lin ◽  
Chung-Chieh Yu ◽  
Chung-Ching Hua ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Liver Cirrhosis ◽  
Empiric Antibiotic Therapy ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
History Of ◽  
Hospital Acquired Pneumonia ◽  
Healthcare Associated ◽  
Hospital Acquired

Background.The risk factors forStaphylococcus aureus(S. aureus) pneumonia are not fully identified. The aim of this work was to find out the clinical characteristics associated withS. aureusinfection in patients with healthcare-associated pneumonia (HCAP) and hospital-acquired pneumonia (HAP), which may be applicable for more appropriate selection of empiric antibiotic therapy.Methods.From July 2007 to June 2010, patients who were admitted to the intensive care unit with severe HCAP/HAP and severe sepsis were enrolled in this study. Lower respiratory tract sample was semiquantitatively cultured. Initial broad-spectrum antibiotics were chosen by Taiwan or American guidelines for pneumonia management. Standard bundle therapies were provided to all patients according to the guidelines of the Surviving Sepsis Campaign.Results.The most frequently isolated pathogens werePseudomonas aeruginosa,S. aureus,Acinetobacter baumannii,Klebsiella pneumoniae, andEscherichia coli. Patients with positive isolation ofS. aureusin culture had significantly higher history of liver cirrhosis and diabetes mellitus, with odds ratios of 3.098 and 1.899, respectively. TheS. aureuspneumonia was not correlated with history of chronic obstructive pulmonary disease, hypertension, and hemodialysis.Conclusion.Liver cirrhosis and diabetes mellitus may be risk factors forS. aureusinfection in patients with severe HCAP or HAP.

scholarly journals Prognosis and risk factors of ERCP pancreatitis in elderly

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Erhan Ergin ◽  
Nevin Oruç ◽  
Galip Ersöz ◽  
Oktay Tekeşin ◽  
Ömer Özütemiz
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Elderly Patients ◽  
Biochemical Analysis ◽  
Female Gender ◽  
The Elderly ◽  
Imaging Findings ◽  
Endoscopic Retrograde ◽  
Sphincter Oddi ◽  
Oddi Dysfunction

AbstractPost Endoscopic Retrograde Cholangiopancreatography (ERCP) pancreatitis is one of the most serious complications of ERCP. Our study aims to investigate the risk, predisposing factors and prognosis of pancreatitis after ERCP in elderly patients. Patients referred to the ERCP unit between April 2008 and 2012 and admitted to the hospital at least 1 day after the ERCP procedure were included to the study. Information including patient’s demographics, diagnosis, imaging findings, biochemical analysis, details of the ERCP procedure and complications were recorded. The severity of post ERCP pancreatitis (PEP) was determined by revised Atlanta Criteria as well as APACHE II and Ranson scores. A total of 2902 ERCP patients were evaluated and 988 were included to the study. Patients were divided into two groups as ≥ 65 years old (494 patients, 259 F, 235 M) and < 65 years old (494 patients, 274 F, 220 M). PEP was diagnosed in 4.3% of patients aged 65 years and older. The female gender was risk factors in elderly for PEP. The Sphincter Oddi Dysfunction (SOD) and Juxta papillary diverticula (JPD) were higher in elderly patients with PEP. Age did not increase the risk of PEP development. The most important post ERCP pancreatitis risk factor in the elderly is the female gender, while the risk is enhanced slightly by SOD and JPD.

Sign in / Sign up

Export Citation Format

Share Document