Hospitalized Infections in People with Osteoarthritis: A National U.S. Study

2020 ◽  
pp. jrheum.191383
Author(s):  
Jasvinder A. Singh ◽  
John D. Cleveland
Keyword(s):  
Healthcare Utilization ◽  
Opportunistic Infections ◽  
Hospital Charges ◽  
Inhospital Mortality ◽  
Infection Rates ◽  
Urban Hospital ◽  
Large Hospital ◽  
Home Setting ◽  
Serious Infection ◽  
Serious Infections

Objective To study the incidence, time-trends and outcomes of serious infections in people with osteoarthritis. Methods We used the 1998-2016 U.S. National Inpatient Sample data. We examined the epidemiology of five hospitalized, i.e., serious infections (opportunistic infections (OI), skin and soft tissue infections (SSTI), urinary tract infection (UTI), pneumonia, and sepsis/bacteremia) in people with osteoarthritis, using recommended weights. We performed multivariable-adjusted logistic regression analyses to analyze factors associated with healthcare utilization (hospital charges, length of hospital stay, discharge to non-home setting), and in-hospital mortality. Results Of all serious infection hospitalizations, 46,708,154 were without osteoarthritis, and 3,258,416 had osteoarthritis. Respectively, people with OA were 16 years older, more likely to be female (52% vs. 65%), White (59% vs. 70%), have Deyo-Charlson index score ≥2 (41% vs 51%), Medicare (54% vs. 80%), and less likely to receive care at an urban teaching hospital (45% vs. 39%). Serious infection rates /100,000 NIS hospitalizations increased from 1998-2000 to 2015-2016: OI from 4.5 to 7.2; SSTI, 48.3 to 145.8; UTI, 8.4 to 104.6; pneumonia, 164.0 to 224.3; sepsis, 39.4 to 436.3. In multivariable-adjusted analyses, older age, higher Deyo-Charlson score, sepsis, Northeast region, urban hospital and medium or large hospital bed size were significantly associated with higher healthcare utilization outcomes and inhospital mortality; and Medicaid insurance, non-White race, and female sex with higher healthcare utilization. Conclusion Serious infection rates have increased in people with osteoarthritis. Association of demographic, clinic and hospital variables with serious infection outcomes identifies potential targets for future interventions.

scholarly journals Serious Infections in People with Scleroderma: A National U.S. Study

2020 ◽  
Author(s):  
Jasvinder Singh ◽  
John D. Cleveland
Keyword(s):  
Hospital Mortality ◽  
Hospital Stay ◽  
Healthcare Utilization ◽  
Time Trends ◽  
Opportunistic Infections ◽  
Length Of Hospital Stay ◽  
Hospital Charges ◽  
Home Setting ◽  
Serious Infection ◽  
Serious Infections

Abstract Objective: To study incidence, time-trends and outcomes of serious infections in scleroderma. Methods: We used the 1998-2016 U.S. National Inpatient Sample data. We examined the epidemiology, time-trends and outcomes of five serious infections (opportunistic infections (OI), skin and soft tissue infections (SSTI), urinary tract infection (UTI), pneumonia, and sepsis/bacteremia) in hospitalized people with scleroderma. We performed multivariable-adjusted logistic regression analyses to analyze independent association of factors with healthcare utilization (hospital charges, length of hospital stay, discharge to non-home setting), and in-hospital mortality. Results: There were 49,904,955 hospitalizations with serious infections in people without scleroderma and 61,615 in those with scleroderma. During 1998-2016, the most common serious infections in scleroderma were pneumonia (45%), sepsis (32%), SSTI (19%), UTI (3%) and OI (3%). In 2013-14, sepsis surpassed pneumonia as the most common serious infection; by 2015-16, sepsis was 1.8-times more common than pneumonia. Over the study period, hospital charges increased, while length of hospital stay and in-hospital mortality decreased, overall and for each serious infection. Multivariable-adjusted analyses showed that sepsis, age ≥80 years and Deyo-Charlson score ≥2 were associated with significantly higher odds of healthcare utilization and in-hospital mortality; and Medicare or Medicaid insurance payer, Northeast location, urban teaching or non-teaching hospital, and medium or large hospital bed size with significantly higher odds of healthcare utilization. Conclusions: Outcomes in people with scleroderma hospitalized with serious infections have improved over time, except higher hospital charges. Identification of factors associated with higher healthcare utilization and in-hospital mortality allows for developing interventions to improve outcomes.

scholarly journals Serious Infections in People with Systemic sclerosis: A National U.S. Study

2020 ◽  
Author(s):  
Jasvinder Singh ◽  
John D. Cleveland
Keyword(s):  
Systemic Sclerosis ◽  
Hospital Mortality ◽  
Hospital Stay ◽  
Healthcare Utilization ◽  
Time Trends ◽  
Length Of Hospital Stay ◽  
Hospital Charges ◽  
Home Setting ◽  
Serious Infection ◽  
Serious Infections

Abstract Objective: To study incidence, time-trends and outcomes of serious infections in systemic sclerosis (SSc). Methods: We used the 1998-2016 U.S. National Inpatient Sample data. We examined the epidemiology, time-trends and outcomes of five serious infections (opportunistic infections (OI), skin and soft tissue infections (SSTI), urinary tract infection (UTI), pneumonia, and sepsis/bacteremia) in hospitalized people with SSc. We performed multivariable-adjusted logistic regression analyses to analyze independent association of factors with healthcare utilization (hospital charges, length of hospital stay, discharge to non-home setting), and in-hospital mortality. Results: There were 49,904,955 hospitalizations with serious infections in people without SSc and 61,615 in those with SSc. During 1998-2016, the most common serious infections in SSc were pneumonia (45%), sepsis (32%), SSTI (19%), UTI (3%) and OI (3%). In 2013-14, sepsis surpassed pneumonia as the most common serious infection; by 2015-16, sepsis was 1.8-times more common than pneumonia. Over the study period, hospital charges increased, while length of hospital stay and in-hospital mortality decreased, overall and for each serious infection. Multivariable-adjusted analyses showed that sepsis, age ≥80 years and Deyo-Charlson score ≥2 were associated with significantly higher odds of healthcare utilization and in-hospital mortality; and Medicare or Medicaid insurance payer, Northeast location, urban teaching or non-teaching hospital, and medium or large hospital bed size with significantly higher odds of healthcare utilization. Conclusions: Outcomes in people with SSc hospitalized with serious infections have improved over time, except higher hospital charges. Identification of factors associated with higher healthcare utilization and in-hospital mortality allows for developing interventions to improve outcomes.

WED 187 Infections in ocrelizumab recipients from phase III studies

2018 ◽  
Vol 89 (10) ◽  
pp. A26.3-A27
Author(s):  
Giovannoni Gavin ◽  
Hartung Hans-Peter ◽  
Comi Giancarlo ◽  
de Seze Jérôme ◽  
Hemmer Bernhard ◽  
...  
Keyword(s):  
Opportunistic Infections ◽  
Phase Iii ◽  
System Organ Class ◽  
Primary Progressive Multiple Sclerosis ◽  
Upper Respiratory Tract ◽  
Infection Rates ◽  
Link Type ◽  
Serious Infection ◽  
Serious Infections ◽  
Tract Infections

BackgroundOcrelizumab Phase III study safety findings in relapsing (OPERA I/II [NCT01247324/NCT01412333]) and primary progressive multiple sclerosis (ORATORIO [NCT01194570]) were reported; infections and serious infections are reported here. Methods: Ocrelizumab patients received 600 mg intravenously every 24 weeks for 96 weeks (OPERA I/II) or ≥120 weeks (ORATORIO; 2 × 300 mg infusions 14 days apart every 24 weeks). Controls received interferon beta-1a 44 µg thrice weekly (IFNβ−1a; OPERA I/II) or placebo (ORATORIO). Infections were classified by MedDRA system organ class/preferred term.ResultsNon-serious infection rates in ocrelizumab-treated patients in OPERA were 58.4% (pooled analysis) and ORATORIO 69.8%; comparators were IFNβ−1a 52.4% and placebo 67.8%. Most infections were mild-to-moderate. Common infections (≥10% in either group) reported more in ocrelizumab treated patients were upper respiratory tract infections and either nasopharyngitis (OPERA) or influenza (ORATORIO);<1% of ocrelizumab-treated patients withdrew due to non-serious infections. Serious infections occurred in 1.3% (OPERA) and 6.2% (ORATORIO) of ocrelizumab-treated patients; comparators were IFNβ−1a 2.9% and placebo 5.9%. No infection-related deaths occurred in ocrelizumabtreated patients in OPERA; two deaths occurred in ORATORIO (aspiration pneumonia and pneumonia [unrelated per investigator, related per sponsor]). No opportunistic infections were reported.ConclusionSerious infection rates with ocrelizumab were numerically lower than with IFNβ−1a and similar compared with placebo.

scholarly journals Tofacitinib for the Treatment of Ulcerative Colitis: Analysis of Infection Rates from the Ulcerative Colitis Clinical Programme

2020 ◽  
Author(s):  
Kevin L Winthrop ◽  
Edward V Loftus Jr ◽  
Daniel C Baumgart ◽  
Walter Reinisch ◽  
Chudy I Nduaka ◽  
...  
Keyword(s):  
Ulcerative Colitis ◽  
Viral Infections ◽  
Opportunistic Infections ◽  
Incidence Rates ◽  
Infection Rates ◽  
Open Label ◽  
Treatment Groups ◽  
Serious Infections ◽  
Maintenance Study

Abstract Background and Aims Tofacitinib is an oral, small molecule JAK inhibitor for the treatment of ulcerative colitis. We report integrated analyses of infections in the Phase [P]2 and P3 OCTAVE programmes. Methods Three cohorts were analysed: Induction [P2/3 induction studies]; Maintenance [P3 maintenance study]; and Overall [all tofacitinib-treated patients in induction, maintenance or ongoing, open-label, long-term extension studies; as of May 2019]. Proportions and incidence rates [IRs; unique patients with events/100 patient-years] of serious infections [SIs], herpes zoster [HZ] [non-serious and serious] and opportunistic infections [OIs] are reported [censored at time of event]. Results In the Induction Cohort [N=1220], no patients receiving placebo and eight [0.9%] receiving tofacitinib 10mg twice daily [BID] developed SIs. Maintenance Cohort [N=592] SI IRs [95% CI] were 1.94 [0.23–7.00] for placebo, and 1.35 [0.16–4.87] and 0.64 [0.02–3.54] for tofacitinib 5 and 10mg BID, respectively; HZ IRs were 0.97 [0.02–5.42], 2.05 [0.42–6.00] and 6.64 [3.19–12.22], respectively. In the Overall Cohort [N=1157; 82.9% predominantly received tofacitinib 10mg BID], SI, HZ and non-HZ OI IRs were 1.70 [1.24–2.27], 3.48 [2.79–4.30] and 0.15 [0.04–0.38], respectively. No SIs resulted in death. Conclusions During induction, SIs were more frequent with tofacitinib versus placebo. SIs were generally infrequent in the Maintenance and Overall Cohorts, with rates comparable between treatment groups. Maintenance Cohort HZ IR was numerically higher with tofacitinib 10 versus 5mg BID. Overall Cohort HZ IRs remained stable over time. Non-HZ OIs and viral infections were rare.

scholarly journals Sjogren’s Syndrome is associated with higher healthcare utilization after primary hip, but not primary knee arthroplasty: A U.S. cohort study

2020 ◽  
Author(s):  
Jasvinder A Singh ◽  
John D. Cleveland
Keyword(s):  
Hospital Stay ◽  
Healthcare Utilization ◽  
Length Of Hospital Stay ◽  
Sjogren’S Syndrome ◽  
Sjogren's Syndrome ◽  
Hospital Charges ◽  
Implant Infection ◽  
Home Setting ◽  
Primary Thas ◽  
Primary Tkas

Abstract Objective: To assess whether Sjogren’s Syndrome (SS) is associated with outcomes after total knee or hip arthroplasty (TKA/THA).Methods: We used the 1998-2014 U.S. National Inpatient Sample data. We performed multivariable-adjusted logistic regression analyses to assess the association of SS with healthcare utilization (hospital charges, length of hospital stay, discharge to non-home setting), and in-hospital complications (implant infection, revision, transfusion, mortality), controlling for important covariates and confounders. In sensitivity analyses, we additionally adjusted the main models for hospital location/teaching status, bed size, and region.Results: We examined 4,116,485 primary THAs and 8,127,282 primary TKAs performed from 1998-2014; 12,772 (0.2%) primary TKAs and 6,222 (0.2%) primary THAs were done in people with SS. In multivariable-adjusted models, SS was associated with a statistically significant higher odds ratio (OR; 95% confidence interval (CI)) of discharge to a rehabilitation/inpatient facility post-THA, 1.13 (1.00, 1.28), but not post-TKA, 0.93 (0.86, 1.02). We noted no differences in the length of hospital stay or hospital charges. SS was associated with significantly higher adjusted odds of in-hospital transfusion post-THA, 1.37 (1.22, 1.55) and post-TKA, 1.21 (1.10, 1.34). No significant differences by SS diagnosis were seen in hospital stay, hospital charges implant infection, implant revision or mortality rates.Conclusions: People with SS had higher transfusion rate post-TKA/THA, and higher rate of discharge to non-home setting post-THA. The lack of association of SS with post-arthroplasty complications should reassure patients, surgeons and policy-makers about the utility of TKA/THA in people with SS undergoing these procedures.

scholarly journals Trends in Serious Infections in Rheumatoid Arthritis

2013 ◽  
Vol 40 (5) ◽  
pp. 611-616 ◽  
Author(s):  
Orla M. Ni Mhuircheartaigh ◽  
Eric L. Matteson ◽  
Abigail B. Green ◽  
Cynthia S. Crowson
Keyword(s):  
Rheumatoid Arthritis ◽  
Geographical Area ◽  
Population Based ◽  
Infection Rates ◽  
Inception Cohort ◽  
Serious Infection ◽  
Intravenous Antibiotics ◽  
Serious Infections ◽  
History Of ◽  
Gi Infections

Objective.To examine trends in the rates of serious infections among patients diagnosed with rheumatoid arthritis (RA) in 1995–2007 compared to rates previously reported from the same geographical area diagnosed 1955–1994.Methods.A population-based inception cohort of patients with RA in 1995–2007 was assembled and followed through their complete medical records until death, migration, or December 31, 2008. All serious infections (requiring hospitalization or intravenous antibiotics) were recorded. Person-year (py) methods were used to compare rates of infection.Results.Among 464 patients with incident RA in 1995–2007, 54 had ≥ 1 serious infection (178 total). These were compared to 609 patients with incident RA in 1955–1994 (290 experienced ≥ 1 serious infection; 740 total). The rate of serious infections declined from 9.6 per 100 py in the 1955–1994 cohort to 6.6 per 100 py in the 1995–2007 cohort. Serious gastrointestinal (GI) infection rates increased from 0.5 per 100 py in the 1955–1994 cohort to 1.25 per 100 py in the 1995–2007 cohort. Among patients with a history of serious infection, the rate of subsequent infection increased from 16.5 per 100 py in 1955–1994 to 37.4 per 100 py in 1995–2007. There was an increase in the rate of serious infections in patients who received biologic agents, but this did not reach significance.Conclusion.Aside from GI infections, the rate of serious infections in patients with RA has declined in recent years. However, the rate of subsequent infections was higher in recent years than previously reported.

scholarly journals Sjogren’s Syndrome is associated with higher healthcare utilization after primary hip, but not primary knee arthroplasty: A U.S. cohort study

2020 ◽  
Author(s):  
Jasvinder A Singh ◽  
John D. Cleveland
Keyword(s):  
Hospital Stay ◽  
Healthcare Utilization ◽  
Length Of Hospital Stay ◽  
Sjogren’S Syndrome ◽  
Sjogren's Syndrome ◽  
Hospital Charges ◽  
Implant Infection ◽  
Home Setting ◽  
Primary Thas ◽  
Primary Tkas

Abstract Objective: To assess whether Sjogren’s Syndrome (SS) is associated with outcomes after total knee or hip arthroplasty (TKA/THA). Methods: We used the 1998-2014 U.S. National Inpatient Sample data. We performed multivariable-adjusted logistic regression analyses to assess the association of SS with healthcare utilization (hospital charges, length of hospital stay, discharge to non-home setting), and in-hospital complications (implant infection, revision, transfusion, mortality), controlling for important covariates and confounders. In sensitivity analyses, we additionally adjusted the main models for hospital location/teaching status, bed size, and region . Results: We examined 4,116,485 primary THAs and 8,127,282 primary TKAs performed from 1998-2014; 12,772 (0.2%) primary TKAs and 6,222 (0.2%) primary THAs were done in people with SS. In multivariable-adjusted models, SS was associated with a statistically significant higher odds ratio (OR; 95% confidence interval (CI)) of discharge to a rehabilitation/inpatient facility post-THA, 1.13 (1.00, 1.28), but not post-TKA, 0.93 (0.86, 1.02). We noted no differences in the length of hospital stay or hospital charges. SS was associated with significantly higher adjusted odds of in-hospital transfusion post-THA, 1.37 (1.22, 1.55) and post-TKA, 1.21 (1.10, 1.34). No significant differences by SS diagnosis were seen in hospital stay, hospital charges implant infection, implant revision or mortality rates. Conclusions: People with SS had higher transfusion rate post-TKA/THA, and higher rate of discharge to non-home setting post-THA. The lack of association of SS with post-arthroplasty complications should reassure patients, surgeons and policy-makers about the utility of TKA/THA in people with SS undergoing these procedures.

scholarly journals 1095. Investigation of Risk Factors Associated with Serious Bacterial, Viral and Invasive Fungal Infections in Hematologic Patients on Ibrutinib

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S576-S577
Author(s):  
Thomas Holowka ◽  
Harry Cheung ◽  
Maricar F Malinis ◽  
Sarah Perreault ◽  
Iris Isufi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Fungal Infections ◽  
Antimicrobial Prophylaxis ◽  
Hematologic Malignancy ◽  
Invasive Fungal Infections ◽  
Risk Of Infection ◽  
Factors Associated ◽  
Serious Infection ◽  
Increased Risk ◽  
Serious Infections

Abstract Background Ibrutinib is a tyrosine kinase inhibitor used to treat hematologic malignancies that may increase the risk of serious infection including invasive fungal infections (IFI). In a study of 378 patients with hematologic malignancy on ibrutinib, serious infection and IFI occurred in 11% and 4% respectively (Varughese et al. Clin Infect Dis). The primary aims of our study were to determine the incidence of serious infection and associated risk factors in patients on ibrutinib. Methods We performed a retrospective analysis of patients with hematologic malignancy prescribed ibrutinib for ≥ 1 week at Yale New Haven Hospital from 2014 to 2019 to identify serious infections defined as those requiring inpatient management. We collected demographic, clinical and oncologic data. Chi-squared tests were used to determine factors associated with an increased risk of infection. Results A total of 254 patients received ibrutinib including 156 with CLL, 89 with NHL and 9 with other leukemias. Among these, 21 underwent HSCT, 9 complicated by GVHD. There were 51 (20%) patients with serious infections including 45 (17.7%) bacterial, 9 (3.5%) viral and 5 (2%) IFI (1 pulmonary cryptococcosis, 4 pulmonary aspergillosis). Anti-mold prophylaxis was prescribed to 7 (2.8%) patients, none of whom developed IFI. Risk factors associated with serious infection included ECOG score ≥ 2 (OR 4.6, p &lt; 0.001), concurrent steroid use (≥ 10 mg prednisone daily for ≥ 2 weeks; OR 3.0, p &lt; 0.001), neutropenia (OR 3.6, p &lt; 0.01), lymphopenia (OR 2.4, p &lt; 0.05) and maximum ibrutinib dose of 560 mg (OR 2, p &lt; 0.05). There was a dose dependent increase in infections based on number of chemotherapy regimens prior to ibrutinib initiation: 14.3% with 0, 19.7% with 1-2 and 28.7% with ≥ 3 prior treatments. Conclusion The incidence of serious infection in hematologic patients on ibrutinib was higher than previously reported (20% versus 11%) but the rate of IFI was lower (2% versus 4%). High ECOG score, leukopenia, steroids, and higher ibrutinib doses were associated with an increased risk for serious infection. Targeted antimicrobial prophylaxis should be considered for patients on ibrutinib with these risk factors. Improving functional status may also reduce the risk of infection in patients on ibrutinib. Disclosures All Authors: No reported disclosures

scholarly journals Tuberculosis with malaria or HIV co-infection in a large hospital in Luanda, Angola

2013 ◽  
Vol 7 (03) ◽  
pp. 269-272 ◽  
Author(s):  
Emília Valadas ◽  
Augusto Gomes ◽  
Ana Sutre ◽  
Sara Brilha ◽  
Afonso Wete ◽  
...  
Keyword(s):  
Public Health ◽  
Plasmodium Falciparum ◽  
Hospital Stay ◽  
Infection Rate ◽  
Current Data ◽  
Infection Rates ◽  
Large Hospital ◽  
Predominant Species ◽  
Integrated Approaches ◽  
Overall Mortality

Introduction: Three major public health problems, tuberculosis, malaria and HIV/AIDS, are widespread in Angola, often as co-infections in the same individual. In 2009, it was assumed that 44,151 new cases of TB occurred in Angola. Interestingly, interventions such as treatment/prevention of malaria appear to reduce mortality in HIV-infected and possibly TB co-infected patients. However, despite the seriousness of the situation, current data on TB and co-infection rates are scarce. This study aimed to characterize all TB cases seen at the Hospital Sanatório de Luanda, and to determine the co-infection rate with HIV and/or malaria. Methodology: This retrospective study collected demographic, diagnostic and clinical data from all patients admitted during 2007. Results: A total of 4,666 patients were admitted, of whom 1,906 (40.8%) were diagnosed with TB. Overall, 1,111 patients (58.3%) were male and most patients (n=1302, 68.3%) were adults (≥14 years). The rate of HIV co-infection was 37.4% (n=712).  Malaria was diagnosed during admission and hospital stay in 714 patients (37.5%), with Plasmodium falciparum the predominant species. Overall mortality was 15.2% (n=290). Conclusions: Because Luanda does not have the infrastructure to perform culture-based diagnosis of TB, confirmation of TB is problematic. The HIV-co-infection rate is high, with 37.4% of patients requiring integrated approaches to address this problem. With more than 1/3 of the TB patients co-infected with malaria, even during the hospital stay, the prevention of malaria in TB patients appears to be an effective way to reduce overall mortality.

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