infectious complication
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PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262113
Author(s):  
Hon-Fan Lai ◽  
Ivy Yenwen Chau ◽  
Hao-Jan Lei ◽  
Shu-Cheng Chou ◽  
Cheng-Yuan Hsia ◽  
...  

Purpose To evaluate the incidence and risk factors of postoperative fever (POF) after liver resection. In patients with POF, predictors of febrile infectious complications were determined. Methods A total of 797 consecutive patients undergoing liver resection from January 2015 to December 2019 were retrospectively investigated. POF was defined as body temperature ≥ 38.0°C in the postoperative period. POF was characterized by time of first fever, the highest temperature, and frequency of fever. The Institut Mutualiste Montsouris (IMM) classification was used to stratify surgical difficulty, from grade I (low), grade II (intermediate) to grade III (high). Postoperative leukocytosis was defined as a 70% increase of white blood cell count from the preoperative value. Multivariate analysis was performed to identify risk factors for POF and predictors of febrile infectious complications. Results Overall, 401 patients (50.3%) developed POF. Of these, 10.5% had the time of first fever > postoperative day (POD) 2, 25.9% had fever > 38.6°C, and 60.6% had multiple fever spikes. In multivariate analysis, risk factors for POF were: IMM grade III resection (OR 1.572, p = 0.008), Charlson Comorbidity Index score > 3 (OR 1.872, p < 0.001), and serum albumin < 3.2 g/dL (OR 3.236, p = 0.023). 14.6% patients developed infectious complication, 21.9% of febrile patients and 7.1% of afebrile patients (p < 0.001). Predictors of febrile infectious complications were: fever > 38.6°C (OR 2.242, p = 0.003), time of first fever > POD2 (OR 6.002, p < 0.001), and multiple fever spikes (OR 2.039, p = 0.019). Sensitivity, specificity, positive predictive value and negative predictive value for fever > 38.6°C were 39.8%, 78.0%, 33.7% and 82.2%, respectively. A combination of fever > 38.6°C and leukocytosis provided high specificity of 95.2%. Conclusion In this study, we found that IMM classification, CCI score, and serum albumin level related with POF development in patients undergone liver resection. Time of first fever > POD2, fever > 38.6°C, and multiple fever spikes indicate an increased risk of febrile infectious complication. These findings may aid decision-making in patients with POF who require further diagnostic workup.


Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4668-4668
Author(s):  
Annika Kasprzak ◽  
Julia Andresen ◽  
Barbara Hildebrandt ◽  
Kathrin Nachtkamp ◽  
Andrea Kündgen ◽  
...  

Abstract Introduction: Infections are a well-recognized complication in patients (pts) with myelodysplastic syndromes (MDS) that contribute substantially to the morbidity and mortality particularly in pts suffering from neutropenia. Neutropenia and other immune defects including impaired neutrophil function have been reported to be predisposing factors for severe infections. Furthermore, some of the therapies may worsen neutropenia and lead to an additional risk factor to develop infectious episodes. Since infectious complications are no primary endpoint in clinical trials epidemiological data on infections in large cohorts of MDS pts is sparse. Methods: We performed a retrospective analysis of 3.787 MDS-patients from the Duesseldorf MDS Registry who were diagnosed between 1980 and 2018. Infectious complications were defined as clinical symptoms of infection associated with the need for antibiotic and/or antifungal therapy, and/or the isolation of a pathogen and/or an identifiable site of infection by physical examination. Infectious episodes were categorized as fever of unknown origin, microbiologically or clinically documented infection. Results: Amongst our study cohort, 42% of the pts suffered from at least one infectious complication of any type during the course of their disease. Most infectious diseases were of bacterial origin (34.7%) and in 17% a pathogen was isolated. Pneumonia was the most common site of infection (64%). Pts who experienced at least one infectious episode had a significant poorer overall survival (OS) than pts without such events (21 vs 37 months, p&lt;0.001). Pts with a higher risk disease according to the IPSS-R had fewer infections during the course of the disease than pts with a lower-risk MDS (487 total infections vs 1481, p&lt;0.001). Nevertheless, the presence of any infectious episode lead to an inferior OS in lower-risk (40 vs 29 months, p&lt;0.001) as well as in higher-risk disease (38 vs 24 months, p=0.006). In univariate analyses comparing pts who had no infections versus those who had one or more, pts with older age (&gt;65 years) tended to have a higher incidence of infectious episodes (p&lt;0.001). In addition, patients older than 65 suffering from infections had a shorter OS than patients who did not experience an infectious complication. The difference in OS was highly significant with 16 months for pts suffering from infectious complications compared to 24 months (p&lt;0.001). Likewise, an excruciating higher incidence of infections was noted in MDS pts compared to infections incidence in a non-MDS population in Germany. The risk of a 65-year-old or older MDS pt to suffer from pneumonia was 6.9 times higher compared to a non-MDS pt of the same age. We found a highly significant negative correlation between the depth of cytopenia in all three myeloid lineages and the presence of infections (p&lt;0.001), suggesting that patients with severe cytopenia suffer from infectious episodes more frequently. However, pts with an isolated neutropenia having an absolute neutrophil count below a threshold of 0.8 × 10 9/L and suffering from infectious episodes had no inferior OS than neutropenic pts without any infection (25 vs 32 months, p=0.583). Pts with isolated severe thrombocytopenia with a platelet count &lt;50 × 10 9/L had a similar OS of 26 months for pts with infectious complications. The difference in OS between pts with and without infections was even more pronounced in this group (26 vs 48 months, p=0.002). Still, a low hemoglobin (Hb) level &lt;9g/dl appeared to be the most significant risk factor for pts with infections, resulting in the poorest OAS of only 17 months in pts with isolated anemia suffering from infections. In multivariate analyses, we found that Hb &lt;9g/dl, followed by ANC &lt;0.8 × 10 9/L, were independently associated with the risk to suffer from an infection during the disease. In addition, a Hb &lt;9g/dl was the most important blood count parameter with regard to OS when compared to platelets &lt;50 × 10 9/L, and ANC &lt;0.8 × 10 9/L. Conclusion: The incidence of infections significantly increases in pts with advanced age. MDS-pts in general are more vulnerable for infection-related morbidity and mortality than non-MDS-pts. Low hemoglobin and platelet counts were both found to be associated with a worse prognosis compared to low neutrophil counts. The appearance of at least one infectious episode leads to an inferior Disclosures Nachtkamp: Jazz: Speakers Bureau; bsh medical: Speakers Bureau; Celgene: Other: Travel Support. Kobbe: Celgene: Research Funding. Gattermann: Celgene: Honoraria; Takeda: Research Funding; Novartis: Honoraria. Germing: Novartis: Honoraria, Research Funding; Jazz Pharmaceuticals: Honoraria; Celgene: Honoraria; Bristol-Myers Squibb: Honoraria, Other: advisory activity, Research Funding; Janssen: Honoraria.


2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Matthijs Van den Dop ◽  
Dimitri Sneiders ◽  
Gert-Jan Kleinrensink ◽  
Hans Jeekel ◽  
Johan Lange ◽  
...  

Abstract Aim Prophylactic mesh reinforcement has proven to reduce the incidence of incisional hernia (IH). Fear of infectious complications may withhold the widespread implementation of prophylactic mesh reinforcement, particularly in the onlay position. Material and Methods Patients scheduled for elective midline surgery were randomly assigned to a suture closure group, onlay mesh group, or sublay mesh group. The incidence, treatment, and outcomes of patients with infectious complications were assessed through examining the adverse event forms. Data were collected prospectively for 2 years after the index procedure. Results Overall, infectious complications occurred in 14/107 (13.3%) patients in the suture group and in 52/373 (13.9%) patients with prophylactic mesh reinforcement (p = 0.821). Infectious complications occurred in 17.6% of the onlay group and 10.3% of the sublay group (p = 0.042). Excluding anastomotic leakage as a cause, these incidences were 16% (onlay) and 9.7% (sublay), p = 0.073. The mesh could remain in-situ in 40/52 (77%) patients with an infectious complication. The 2-year IH incidence after onlay mesh reinforcement was 10 in 33 (30.3%) with infectious complications and 15 in 140 (9.7%) without infectious complications (p = 0.003). This difference was not statistically significant for the sublay group. Conclusions Prophylactic mesh placement was not associated with increased incidence, severity, or need for invasive treatment of infectious complications compared with suture closure. Patients with onlay mesh reinforcement and an infectious complication had a significantly higher risk of developing an incisional hernia, compared with those in the sublay group.


2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S60-S60
Author(s):  
Courtney Harris ◽  
Lara Coakley ◽  
Mandeep R Mehra ◽  
Hari R Mallidi ◽  
Lindsey R Baden ◽  
...  

Abstract Background Left ventricular assist devices (VAD) have significantly increased survival for patients with advanced heart failure. While advancements in devices during the past 10 years have improved thrombotic and bleeding complications, infection remains a significant cause of morbidity and mortality. We assessed the incidence and risk factors of VAD infections at our institution. Methods A single center, retrospective study of patients who had VAD implanted between January 2007 and December 2020 was performed. Patients with concurrent right sided mechanical circulatory support devices were excluded. Patient demographics, clinical characteristics, labs, microbiology data, and antimicrobials were obtained from the electronic medical records. Clinical outcomes were adjudicated by 2 independent physicians. VAD infections were classified using the ISHLT 2011 guidelines. Results 241 patients had durable VAD implanted in this 14-year period, with a median time of 3 years follow-up. 134 (56%) patients had a clinically significant infection; 42 (31.3%) were VAD specific infections, 42 (31.3%) were VAD related, and 50 (37.4%) were non-VAD related. 95% of VAD specific infections were driveline site infections. 98% of patients with VAD related infections had a concurrent blood stream infection. Of the 50 non-VAD infections, 72% involved either a lower respiratory, urinary tract, or Clostridium difficile infection. Median time from VAD implantation to infection was 5 months. 44 (32.8%) had their first infection during the index hospitalization, of which 27 (61.4%) were non-VAD infections. 78 (58.2%) had one infection, compared with 38 (28.4%) who had two or more infections. 17 (12.7%) had recurrence of their initial infection and 6 (35%) occurred despite being on suppressive antibiotics. 48 of 134 (36%) infected patients were transplanted. 57 of 134 (42.5%) died compared to 33 of 107 (31%) without an infection. Conclusion More than half of VAD patients at our center during a 14-year time period had an infectious complication and higher mortality rate compared to those without an infectious complication. Further studies are needed to assess the immunologic risk factors for the increased risk of non-device associated infections in VAD patients. Disclosures Mandeep R. Mehra, MD, Abbott (Consultant)Baim Institute for Clinical Research (Consultant)FineHeart (Consultant)NupulseCV (Consultant) Ann E. Woolley, MD, MPH, COVAX (Consultant)


2021 ◽  
Vol 6 (4) ◽  
pp. 202-212
Author(s):  
A. N. Grishchuk ◽  
S. N. Leonova ◽  
A. L. Kameka

Despite of intensive work on improving endoprosthetic replacement constructions, using minimally invasive techniques, developing methods of prevention for and treatment of periprosthetic joint infection, relapse of infection process can reach up to 52 % after treatment.The aim of the study: to show the importance of identifying the risks of development and recurrence of periprosthetic infection after implantation of a knee joint endoprosthesis. A clinical case of the development of a deep periprosthetic infection in a patient after primary knee replacement and successful treatment of the resulting complication was demonstrated. The analysis of this case of an infectious complication using the proposed prognosis for the development of periprosthetic infection showed that before surgical treatment of the patient, the risk of an infectious process was not assessed, and appropriate preventive and therapeutic measures were not carried out.Materials and methods. In the treatment of developed periprosthetic infection of the knee joint, the author’s algorithm for choosing surgical tactics was used, which allowed to determine the high risk of recurrence of periprosthetic infection, evaluate additional criteria and choose the optimal type of surgical intervention – two-stage revision endoprosthetic, which allowed to stop the infectious process.New was the use of the proposed prognosis for the development of periprosthetic infection and the algorithm for choosing surgical tactics for periprosthetic infection, which make it possible to determine the necessary preventive measures to reduce the risk of an infectious complication and to apply the optimal type of surgical intervention to relieve periprosthetic knee infection.


2021 ◽  
Vol 33 ◽  
pp. 99-101
Author(s):  
Walter Lunardi ◽  
Sonia Bianchi

Introduction: Exit-site (ES) and tunnel infections are the main infectious complication in peritoneal dialysis (PD); they also are risk factors for the development of peritonitis, for catheter removal and for dialysis drop-out. Up to now, besides the recommendations of the Guidelines there is no uniformity, nor on the classification, nor on the treatment strategies of the infected ES. Recent experiences are reported with alternative types of dressings that aim to reduce the incidence of ES infection and consequently of the subcutaneous tunnel. Methods: The Tuscan group conducted a retrospective observational study of 10 patients on PD who, showing signs of a suspected but not ascertained infection (negative microbiological culture), such as redness, edema, secretion, scab, had been medicated with silver-ions releasing Exit-Pad Ag. The aim was to evaluate and classify the evolution of ES lesions, in order to confirm the preventive efficacy of the silver-ions releasing dressing compared to the traditional ones. Results: After 4 weeks of treatment with Exit Pad Ag maintained in situ for 72 h, 6 patients no longer had any signs of inflammation. In 2 cases, several weeks of treatment were necessary to achieve a complete recovery, while in 2 other cases the signs of inflammation became negative in less time (2 weeks, 1 week). Conclusions: With the utilization of an alternative dressing such as Exit-Pad Ag on PD patients showing early signs of inflammation, the onset of a true infection can be prevented, with a progressive improvement of the ES.


2021 ◽  
Vol 14 (9) ◽  
pp. e244336
Author(s):  
Brendan Wechsler ◽  
Jonah Devries ◽  
Douglas Yim

Pubic symphysis osteomyelitis is an infectious complication that rarely arises in men who have undergone treatment for prostate cancer. This process may more rarely arise from a fistulous tract between the pubic symphysis and the urinary tract. In this case report, we discuss the most common clinical presentations and laboratory findings that lead to the diagnosis of this disease process, as well as the role of MRI and other imaging modalities in confirmation of the diagnosis. This case serves as a reminder to clinicians to have earlier consideration of pubic symphysis osteomyelitis in their differential diagnosis to reduce the risk of long-term complications associated with undertreatment.


Author(s):  
L. Matthijs Van den Dop ◽  
Dimitri Sneiders ◽  
Gert-Jan Kleinrensink ◽  
Hans J. Jeekel ◽  
Johan F. Lange ◽  
...  

Author(s):  
Andrea I Zambrano ◽  
Elizabeth C Church ◽  
Kenneth M McKay ◽  
Stephanie K Carnes ◽  
Ryan J Morse ◽  
...  

Abstract Patients with rheumatologic conditions can have complex dermatologic manifestations. In addition, immunosuppressing treatment for autoimmune disorders can also increase incidence of infectious complications. Skin conditions in rheumatologic patients present particular challenges and this case highlights a rare infectious complication.


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