An Outbreak of Imipenem-ResistantAcinetobacter baumanniiin Critically Ill Surgical Patients

2001 ◽  
Vol 22 (1) ◽  
pp. 35-40 ◽  
Author(s):  
Lisiane Fierobe ◽  
Jean-Christophe Lucet ◽  
Dominique Decré ◽  
Claudette Muller-Serieys ◽  
Arnaud Deleuze ◽  
...  
Keyword(s):  
Risk Factors ◽  
Therapeutic Intervention ◽  
Case Control Study ◽  
Severity Of Illness ◽  
Case Control ◽  
Control Measures ◽  
Surgical Intensive Care Unit ◽  
Safety Measures ◽  
Environmental Cleaning ◽  
Control Study

AbstractObjective:To describe an outbreak of imipenem-resistantAcinetobacter baumannii(IR-Ab) and the measures for its control, and to investigate risk factors for IR-Ab acquisition.Design:An observational and a case-control study.Setting:A surgical intensive care unit (ICU) in a university tertiary care hospital.Methods:After admission to the ICU of an IR-Ab-positive patient, patients were prospectively screened for IR-Ab carriage upon admission and then once a week. Environmental cleaning and barrier safety measures were used for IR-Ab carriers. A case-control study was performed to identify factors associated with IR-Ab acquisition. Cases were patients who acquired IR-Ab. Controls were patients who were hospitalized in the ICU at the same time as cases and were exposed to IR-Ab for a similar duration as cases. The following variables were investigated as potential risk factors: baseline characteristics, scores for severity of illness and therapeutic intervention, presence and duration of invasive procedures, and antimicrobial administration.Results:Beginning in May 1996, the outbreak involved 17 patients over 9 months, of whom 12 acquired IR-Ab (cases), 4 had IR-Ab isolates on admission to the ICU, and 1 could not be classified. Genotypic analysis identified two different IR-Ab isolates, responsible for three clusters. Ten of the 12 nosocomial cases developed infection. Control measures included reinforcement of barrier safety measures, limitation of the number of admissions, and thorough environmental cleaning. No new case was identified after January 1997. Eleven of the 12 cases could be compared to 19 controls. After adjustment for severity of illness, a high individual therapeutic intervention score appeared to be a risk factor for IR-Ab acquisition.Conclusion:The outbreak ended after strict application of control measures. Our results suggest that high work load contributes to IR-Ab acquisition.

Increased Mortality Associated With a Clonal Outbreak of Ceftazidime-ResistantKlebsiella pneumoniae: A Case–Control Study

2005 ◽  
Vol 26 (1) ◽  
pp. 63-68 ◽  
Author(s):  
Abdul Qavi ◽  
Sorana Segal-Maurer ◽  
Noriel Mariano ◽  
Carl Urban ◽  
Carl Rosenberg ◽  
...  
Keyword(s):  
Infection Control ◽  
Bacterial Infections ◽  
Case Control Study ◽  
Community Hospital ◽  
Case Control ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Environmental Cleaning ◽  
Serious Bacterial Infections ◽  
Control Study

AbstractObjectives:To determine risk factors for ceftazidime-resistantKlebsiella pneumoniaeinfection and the effect of cef-tazidime-resistantK. pneumoniaeinfection on mortality during an isolated outbreak.Design:Case–control investigation using clinical and molecular epidemiology and prospective analysis of infection control interventions.Setting:Surgical intensive care unit of a university-affiliated community hospital.Patients:Fourteen case-patients infected with ceftazidime-resistantK. pneumoniaeand 14 control-patients.Results:Ten of 14 case-patients had identical strains by pulsed-field gel electrophoresis. Broad-spectrum antibiotic therapy before admission to the unit was strongly predictive of subsequent ceftazidime-resistantK. pneumoniaeinfection. In addition, patients with ceftazidime-resistantK. pneumoniaeinfection experienced increased mortality (odds ratio, 3.77).Conclusions:Cephalosporin restriction has been shown to decrease the incidence of nosocomial ceftazidime-resistantK. pneumoniae. However, isolated clonal outbreaks may occur due to lapses in infection control practices. Reinstatement of strict handwashing, thorough environmental cleaning, and repeat education led to termination of the outbreak. A distinct correlation between ceftazidime-resistantK. pneumoniaeinfection and mortality supports the important influence of antibiotic resistance on the outcome of serious bacterial infections.

scholarly journals Risk factors for sporadic Campylobacter infection: an all-Ireland case-control study

2009 ◽  
Vol 14 (7) ◽  
Author(s):  
K Danis ◽  
M Di Renzi ◽  
W O’Neill ◽  
B Smyth ◽  
P McKeown ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Population Attributable Fraction ◽  
Case Control ◽  
Control Measures ◽  
Safety Education ◽  
First Case ◽  
The Republic ◽  
Campylobacter Infection ◽  
Control Study

We report the findings of the first case-control study conducted in both the Republic of Ireland and Northern Ireland to determine risk factors for sporadic Campylobacter infections. A total of 197 cases and 296 case-nominated controls matched for age, were included. Based on Population Attributable Fraction (PAF), the most important risk factors were consuming chicken [adjusted matched (am) OR 6.8; 95%CI 2.1-21.9], consuming lettuce (amOR 3.3; 95%CI 1.5-7.1) and eating in takeaways (amOR=3.1; 95%CI 1.4-6.6). Contact with sheep (amOR=11; 95%CI 1.6-78), peptic ulcer (amOR=19; 95%CI 3.8-93.7), hiatus hernia (amOR=20.3; 95%CI 2.3-183.3), lower bowel problems (amOR=4.5; 95%CI 1.2-16.8) were also independently associated with infection. Mains water supply showed protective effect (amOR=0.2; 95 CI 0.1-0.9). The findings highlight the continued need for consumer food safety education and further control measures throughout the food chain on the island of Ireland.

scholarly journals Predictors for vancomycin resistant Enterococcus faecium transforming from colonization to infection: a case control study

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Pao-Yu Chen ◽  
Yu-Chung Chuang ◽  
Jann-Tay Wang ◽  
Wang-Huei Sheng ◽  
Yee-Chun Chen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Enterococcus Faecium ◽  
Case Control Study ◽  
Case Control ◽  
Control Measures ◽  
Fourth Generation ◽  
Surveillance Culture ◽  
Icu Admission ◽  
Vancomycin Resistant ◽  
Control Study

Abstract Background Little is known about risk factors for subsequent infections among vancomycin resistant Enterococcus faecium (VREfm) colonizers, especially characterized by concordant pulsotypes (CP) of paired colonization and infection-related isolates. Methods This case-control study was conducted at a teaching hospital between 2011 and 2014. Targeted patients received active surveillance culture for VREfm by anal swabs at admission. Cases were those who developed VREfm infection within 180 days after colonization of VREfm. Controls were those colonized with VREfm without subsequent VREfm infection. CP were defined by similarities ≥86.7% using pulsed-field gel electrophoresis between paired colonization and infection-related isolates. Results Ninety-seven cases and 194 controls were enrolled. By conditional multivariable logistic regression analysis, the risk factors for subsequent infection among VREfm colonizers were intensive care unit (ICU) admission (adjusted odds ratio [aOR], 9.32; 95% CI, 3.61–24.02), receipt of central venous catheters (CVC) (aOR, 3.38; 95% CI, 1.30–8.82), and utilization of third- and fourth-generation cephalosporins (aOR, 4.06; 95% CI, 1.79–9.20, and aOR, 5.32; 95% CI, 1.85– 10.29, respectively) (all P ≤ 0.01). Fifty-six (57.7%) of case patients belonged to the CP group, which were associated with ICU admission (aOR, 3.74; 95% CI, 1.38–10.13), and infection developing within 30 days after colonization (aOR, 3.34; 95% CI, 1.25–8.91). Conclusions Among VREfm colonizers, being admitted to ICU and receiving CVC or broad spectrum cephalosporins, were the risk factors for subsequent infections. These findings highlight the importance of conducting more strict infection control measures on specific groups of VREfm colonizers.

Factors Associated With Unplanned Extubation in Children: A Case–Control Study

2017 ◽  
Vol 35 (1) ◽  
pp. 74-81
Author(s):  
Paulo Sérgio Lucas da Silva ◽  
Marcelo Cunio Machado Fonseca
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Oxygenation Index ◽  
Severity Of Illness ◽  
Pediatric Intensive Care ◽  
Case Control ◽  
Admission Diagnosis ◽  
Unplanned Extubation ◽  
Factors Associated ◽  
Control Study

Purpose:Although several studies assess unplanned extubation (UE) in children, few have addressed determinants of UE and factors associated with reintubation in a case-controlled manner. We aimed to identify the risk factors and outcomes associated with UE in a pediatric intensive care unit.Methods:Cases of UE were randomly matched with control patients at a ratio of 1:4 for age, severity of illness, and admission diagnosis. For cases and controls, we also collected data associated with UE events, reintubation, and outcomes.Results:We analyzed 94 UE patients (0.75 UE per 100 intubation days) and found no differences in demographics between the 2 groups. Logistic regression revealed that patient agitation (odds ratio [OR]: 2.44; 95% confidence interval [CI]: 1.28-4.65), continuous sedation infusion (OR: 3.27; 95% CI: 1.70-6.29), night shifts (OR: 9.16; 95% CI: 4.25-19.72), in-charge nurse experience <2 years (OR: 2.38; 95% CI: 1.13-4.99), and oxygenation index (OI) >5 (OR: 76.9; 95% CI: 16.79-352.47) were associated with UE. Risk factors for reintubation after UE included prior level of sedation (COMFORT score < 27; OR: 7.93; 95% CI: 2.30-27.29), copious secretion (OR: 11.88; 95% CI: 2.20-64.05), and OI > 5 (OR: 9.32; 95% CI: 2.45-35.48).Conclusions:This case–control study showed that both patient- and nurse-associated risk factors were related to UE. Risk factors associated with reintubation included lower levels of consciousness, copious secretions, and higher OI. Further evidence-based studies, including a larger sample size, are warranted to identify predisposing factors in UEs.

scholarly journals Another dengue fever outbreak in Eastern Ethiopia—An emerging public health threat

2021 ◽  
Vol 15 (1) ◽  
pp. e0008992
Author(s):  
Mulugeta Asefa Gutu ◽  
Alemayehu Bekele ◽  
Yimer Seid ◽  
Yusuf Mohammed ◽  
Fekadu Gemechu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Dengue Fever ◽  
Case Control Study ◽  
Larval Density ◽  
Case Control ◽  
Control Measures ◽  
Severe Dengue ◽  
Vector Surveillance ◽  
Eastern Ethiopia ◽  
Control Study

Background Dengue Fever (DF) is a viral disease primarily transmitted by Aedes (Ae.) aegypti mosquitoes. Outbreaks in Eastern Ethiopia were reported during 2014–2016. In May 2017, we investigated the first suspected DF outbreak from Kabridahar Town, Somali region (Eastern Ethiopia) to describe its magnitude, assess risk factors, and implement control measures. Methods Suspected DF cases were defined as acute febrile illness plus ≥2 symptoms (headache, fever, retro-orbital pain, myalgia, arthralgia, rash, or hemorrhage) in Kabridahar District residents. All reported cases were identified through medical record review and active searches. Severe dengue was defined as DF with severe organ impairment, severe hemorrhage, or severe plasma leakage. We conducted a neighborhood-matched case-control study using a subset of suspected cases and conveniently-selected asymptomatic community controls and interviewed participants to collect demographic and risk factor data. We tested sera by RT-PCR to detect dengue virus (DENV) and identify serotypes. Entomologists conducted mosquito surveys at community households to identify species and estimate larval density using the house index (HI), container index (CI) and Breteau index (BI), with BI≥20 indicating high density. Results We identified 101 total cases from May 12–31, 2017, including five with severe dengue (one death). The attack rate (AR) was 17/10,000. Of 21 tested samples, 15 (72%) were DENV serotype 2 (DENV 2). In the case-control study with 50 cases and 100 controls, a lack of formal education (AOR [Adjusted Odds Ratio] = 4.2, 95% CI [Confidence Interval] 1.6–11.2) and open water containers near the home (AOR = 3.0, 95% CI 1.2–7.5) were risk factors, while long-lasting insecticide treated-net (LLITN) usage (AOR = 0.21, 95% CI 0.05–0.79) was protective. HI and BI were 66/136 (49%) and 147 per 100 homes (147%) respectively, with 151/167 (90%) adult mosquitoes identified as Ae. aegypti. Conclusion The epidemiologic, entomologic, and laboratory investigation confirmed a DF outbreak. Mosquito indices were far above safe thresholds, indicating inadequate vector control. We recommended improved vector surveillance and control programs, including best practices in preserving water and disposal of open containers to reduce Aedes mosquito density.

Fourth Dengue Fever Outbreak Investigation in Ethiopia: A Case Control Study, July 2015

2019 ◽  
Author(s):  
Diriba Sufa Gemechu ◽  
Yoseph Worku ◽  
Abebe Alemu ◽  
Zewdu Assefa Edea ◽  
Yohannis Dugasa Feyisa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Dengue Fever ◽  
Formal Education ◽  
Case Control Study ◽  
National Laboratory ◽  
Febrile Illness ◽  
Case Control ◽  
Control Measures ◽  
Serum Samples ◽  
Control Study

Abstract Background: Dengue fever is a rapidly emerging vector born infectious disease caused by Dengue virus and it is now one of WHO reportable diseases. About 50 -200 million cases, 20,000 deaths occur annually. In Ethiopia the first outbreak of Dengue fever appeared in Dire Dawa city in 2013, where 9441 cases were recorded. The second Dengue fever outbreak occurred in Afar Region. Third and fourth was in Somali Region in Godey town, 2014 and 2015. In Godey town acute febrile illness cases of unknown cause become increased started from May 27, 2015. We investigated to identify risk factors of Dengue fever outbreak and commence control measures. Methods: A case-control study was conducted in Godey town, Ethiopia from 8-22 July 2015. Cases were defined according to the WHO guideline and controls were individuals with no sign and symptoms living in the same town with cases. We recruited 50 cases and 100 controls in the study. Medical records and line lists were reviewed. Data were collected at household level using structured questionnaires. Twenty-four serum samples collected from cases. Data was analyzed using SPSS 20 software. Result: We identified 223 cases with 0 death, 116 (52%) were male. The mean age of cases was 25.8 years. Ten cases were positive for Dengue fever by PCR at national laboratory. Lack of formal education (AOR=3.1; 95%CI: 1.30-7.49), living with ill person (AOR=2.8; 95%CI: 1.22-6.52), open containers in household (AOR=3.6; 95%CI: 1.34-9.38) and presence of larvae in the water containers (AOR=5.4; 95%CI: 2.33-12.44) were risk factors for the outbreak. Conclusion: Poor household water handling, living with ill person and lack of formal education contributes for occurrence of Dengue fever outbreak in Godey town. Health education and all other interventions associated with use of water and sanitation needs to be part of long-term control of Dengue.

scholarly journals “Risk Factors for Visceral Leishmaniasis in Selected High Endemic Areas of Morang District, Nepal”: A case control study

2019 ◽  
Author(s):  
Punam Kumari Mandal ◽  
Rajendra Raj Wagle ◽  
Ajoy Kumar Thakur ◽  
Surendra Uranw
Keyword(s):  
Risk Factors ◽  
Socioeconomic Status ◽  
Visceral Leishmaniasis ◽  
Case Control Study ◽  
Health Sector ◽  
Case Control ◽  
Extensive Study ◽  
Control Measures ◽  
Health Concern ◽  
Control Study

AbstractVisceral leishmaniasis is a major public health concern in Nepal. During the last few years, several KA outbreaks have been reported from Tarai region including Morang district. A case control study was conducted to assess the risk factors associated with VL in 5 endemic VDC of Morang district with 62 cases already treated from BPKIHS and Koshi zonal hospital and 248 controls selected randomly from the same village. Data collected using semi structured questionnaire from September to November 2013. This study revealed that people living in thatched house, sleeping in ground floor, ownership of animal, history of migration to India (Bihar and Jharkhand) and proximity to other KA cases within 50 m distance of household were strong risk factors for VL. Education remains protective (OR 0.39,95 % CI 0.19-0.79). The association with socioeconomic status showed clear dose – response effect. The odds for VL consistently decreased as the level of socioeconomic status increased (OR 4.26, 3.81). Strengthening surveillance system for early diagnosis and treatment, awareness programme and further extensive study is needed on risk factor, vector and control measures.Author SummaryThis study aims to explore the risk factors for visceral leishmaniasis. Based on findings there is a need to educate people in high-transmission areas how to realize, reduce or avoid environmental factors that favor the survival of the vector in the community. Similarly introduction of more exact surveillance tools in order to improve morbidity and mortality surveillance by health sector. People living in mud thatched houses need to be aware about cracks and crevices in the mud walls, their function as breeding places and how they can be controlled, for example by plastering with lime and mud․. However, a primary condition is that people need to understand the purpose of all these efforts in order to be motivated to put them into practice.

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.

scholarly journals The pandemic of Salmonella Enteritidis phage type 4 reaches Utah: a complex investigation confirms the need for continuing rigorous control measures

2000 ◽  
Vol 125 (1) ◽  
pp. 1-8 ◽  
Author(s):  
J. SOBEL ◽  
A. B. HIRSHFELD ◽  
K. McTIGUE ◽  
C. L. BURNETT ◽  
S. ALTEKRUSE ◽  
...  
Keyword(s):  
Risk Factors ◽  
Salmonella Enteritidis ◽  
Case Control Study ◽  
Phage Type ◽  
Case Control ◽  
Control Measures ◽  
Complex Investigation ◽  
First Case ◽  
Control Study

In 1995, Salmonella Enteritidis (SE) cases in the state of Utah increased fivefold. Isolates were identified as phage type 4 (PT4). Risk factors and sources of infection were investigated in two case-control studies, a traceback of implicated foods, and environmental testing. Forty-three patients with sporadic infections and 86 controls were included in a case-control study of risk factors for infection. A follow-up case-control study of 25 case and 19 control restaurants patronized by case and control patients examined risks associated with restaurant practices. In the first case-control study, restaurant dining was associated with illness (P = 0·002). In the follow-up case-control study, case restaurants were likelier to use > 2000 eggs per week (P < 0·02), to pool eggs (P < 0·05), and to use eggs from cooperative ‘A’ (P < 0·009). Eggs implicated in separately investigated SE PT4 outbreaks were traced to cooperative ‘A’, and SE PT4 was cultured from one of the cooperative's five local farms. We conclude that SE PT4 transmitted by infected eggs from a single farm caused a fivefold increase in human infections in Utah.

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