Multidrug-ResistantPseudomonas aeruginosaCholangitis After Endoscopic Retrograde Cholangiopancreatography: Failure of Routine Endoscope Cultures to Prevent an Outbreak

2004 ◽  
Vol 25 (10) ◽  
pp. 856-859 ◽  
Author(s):  
Thomas G. Fraser ◽  
Sandra Reiner ◽  
Michael Malczynski ◽  
Paul R. Yarnold ◽  
John Warren ◽  
...  
Keyword(s):  
Endoscopic Retrograde Cholangiopancreatography ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Case Control ◽  
Control Analysis ◽  
Surveillance Culture ◽  
Endoscopic Retrograde ◽  
Infectious Morbidity ◽  
Surveillance Cultures ◽  
Case Control Analysis

AbstractBackground:Nosocomial infections due to medical devices are of increasing concern to infection control practitioners. Attempts to prevent such infections have included surveillance cultures of endoscopes and bronchoscopes. In July 2002, the infectious disease consultation service was asked to see three patients with sepsis due to multidrug-resistantPseudomonas aeruginosaafter endoscopic retrograde cholangiopancreatography (ERCP).Objective:To describe an outbreak of multidrug-resistantP. aeruginosasepsis after ERCP at an institution that performs routine surveillance cultures of endoscopes.Design:A traditional outbreak investigation supplemented by pulsed-field gel electrophoresis (PFGE) was undertaken, including a case-control analysis based on the hypothesis that all infected individuals had their ERCP performed with the same endoscope.Setting:A tertiary-care academic medical center.Results:The case-control analysis confirmed the hypothesis that undergoing ERCP with the implicated endoscope was associated with a culture positive forPseudomonas(P= .01). The available strains were identical by PFGE. This outbreak occurred despite a negative surveillance culture of the implicated endoscope 1 month earlier.Conclusions:Infectious morbidity can occur after endoscopy despite negative surveillance cultures. The practice of routine endoscope cultures does not prevent device-related infectious morbidity.

scholarly journals Duodenoscope-Associated Outbreak of a Carbapenem Resistant Enterobacteriaceae

2020 ◽  
Vol 41 (S1) ◽  
pp. s197-s197
Author(s):  
Sung Ran Kim ◽  
Joon Young Song ◽  
Min Hee Cho ◽  
Ji Yeon Song
Keyword(s):  
Gel Electrophoresis ◽  
Case Control ◽  
Pulsed Field Gel Electrophoresis ◽  
Control Analysis ◽  
Endoscopic Retrograde ◽  
Carbapenem Resistant ◽  
Case Control Analysis ◽  
Record Review ◽  
Carbapenem Resistant Enterobacteriaceae ◽  
Cleaning Protocol

Background: We describe and evaluate our outbreak of carbapenem-resistant K. pneumoniae transmitted by contaminated duodenoscopes during endoscopic retrograde cholangiopancreatography (ERCP) procedures. Methods: An outbreak investigation was performed when Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) were identified from bile specimens of 4 patients. The investigation included medical record review, practice audits, and surveillance cultures of duodenoscopes and environmental sites. If available, clinical specimens were obtained from patients who had undergone ERCP in the previous 3 months. Carbapenem-resistant Enterobacteriaceae (CRE) screening cultures were performed to identify additional patients until no CRE cases were detected during 2 consecutive weeks. Pulsed-field gel electrophoresis (PFGE) of KPC-KP isolates was implemented. Results: In total, 12 cases were identified with exposure to duodenoscope from February 2019 through April 2019, including 6 cases with infections and 6 asymptomatic carriers. Case-control analysis showed that 2 specific duodenoscopes would be associated with the KPC-KP outbreak. Duodenoscope reprocessing procedures did not deviate from manufacturer recommendations for reprocessing. After ethylene oxide (EO) gas sterilization, the outbreak was terminated. Conclusions: Meticulous cleaning protocol and enhanced surveillance are necessary to prevent outbreaks of CRE. Notably, enhanced cleaning measures, such as sterilization for duodenoscopes, would be required after procedures with KPC-KP carriers.Funding: NoneDisclosures: None

scholarly journals A 10-YEAR RETROSPECTIVE CASE-CONTROL ANALYSIS OF MEDICATION-RELATED OSTEONECROSIS OF THE JAW AT A MAJOR TERTIARY CARE DENTAL INSTITUTION

2019 ◽  
Vol 128 (1) ◽  
pp. e51
Author(s):  
Dr. Laurel Henderson ◽  
Mrs. Amna Imran ◽  
Ms. Pardis Barati Mahvar ◽  
Mr. Andrew Sanapanya ◽  
Dr. Parish P. Sedghizadeh
Keyword(s):  
Tertiary Care ◽  
Osteonecrosis Of The Jaw ◽  
Case Control ◽  
Control Analysis ◽  
Retrospective Case ◽  
Case Control Analysis

scholarly journals COVID-19 with early neurological and cardiac thromboembolic phenomena—timeline of incidence and clinical features

2021 ◽  
Author(s):  
Uma Sundar ◽  
Sanah Merchant ◽  
Meera Shah ◽  
Amita Mukhopadhyay ◽  
Shaonak Kolte ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Binary Logistic Regression ◽  
Case Control ◽  
Respiratory Support ◽  
Binary Logistic Regression Analysis ◽  
Case Group ◽  
Control Analysis ◽  
Chi Square ◽  
Coronary Syndrome ◽  
Case Control Analysis

Background: At our tertiary care public hospital, we saw COVID-19 presenting with thromboembolic phenomena, indicating a possible early thrombo-inflammatory pathology. Objectives: We documented patients with cardiac and neurological thromboembolic phenomena as a primary presentation of COVID-19, and compared a subset of COVID associated strokes against COVID-19 patients without thrombotic manifestations. Methods: We included all COVID-Stroke and COVID-ACS (COVID-19, with ischemic arterial stroke/Acute Coronary Syndrome presenting prior to/simultaneous with/within 72 hours of systemic/respiratory COVID manifestations) admitted from April to November 2020. In the nested case control analysis, we used unpaired T-test and chi-square test to study differences between COVID-Strokes (case group) and non-thrombotic COVID controls. Results and Conclusions: We noted 68 strokes and 122 ACS associated with COVID-19. ACS peaked in May-June, while stroke admissions peaked later in September-October, possibly because severe strokes may have expired at home during the lockdown. In the case-control analysis, cases (n=43; 12F:31M; mean age 51.5 years) had significantly higher D-Dimer values than controls (n=50; 9F:41M; mean age 51.6 years). Mortality was significantly higher in cases (51.2% vs. 26.0%; p = 0.018). We noted 7.5 times higher mortality in cases versus controls even among patients needing minimal oxygen support. Imaging in 37 patients showed both anterior and posterior circulation territories affected in seven, with almost half of Carotid territory strokes being large hemispherical strokes. Additionally, CT/MRI angiography in 28 strokes showed large vessel occlusions in 19 patients. Death in cases thus probably occurred before progression to intense respiratory support, due to severe central nervous system insult. Binary logistic regression analysis showed respiratory support intensity to be the sole independent predictor of mortality among cases. Respiratory distress could have been due to COVID-19 lung infection or aspiration pneumonia resulting from obtunded sensorium. In controls, mortality was predicted by increasing age, female sex, and respiratory support intensity.

scholarly journals Diminishing returns, increasing risks: Impact of antibiotic duration of therapy on respiratory bacterial isolates in hospitalized patients during the coronavirus disease 2019 (COVID-19) pandemic

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Catherine Li ◽  
Ryan W. Chapin ◽  
Nicholas J. Mercuro ◽  
Christina F. Yen ◽  
Howard S. Gold ◽  
...  
Keyword(s):  
Multidrug Resistant ◽  
Case Control ◽  
Control Analysis ◽  
Gram Negative Bacteria ◽  
Bacterial Isolates ◽  
Gram Negative ◽  
Duration Of Therapy ◽  
Antibiotic Duration ◽  
Case Control Analysis ◽  
Hospital Days

Abstract In 829 hospital encounters for patients with COVID-19, 73.2% included orders for antibiotics; however, only 1.8% had respiratory cultures during the first 3 hospital days isolating bacteria. Case–control analysis of 30 patients and 96 controls found that each antibiotic day increased the risk of isolating multidrug-resistant gram-negative bacteria (MDR-GNB) in respiratory cultures by 6.5%.

scholarly journals Thin-flap (sub-Bowman keratomileusis) versus thick-flap laser in situ keratomileusis for moderate to high myopia: Case-control analysis

2008 ◽  
Vol 34 (12) ◽  
pp. 2073-2078 ◽  
Author(s):  
Dimitri T. Azar ◽  
Ramon C. Ghanem ◽  
Jose de la Cruz ◽  
Joelle A. Hallak ◽  
Takashi Kojima ◽  
...  
Keyword(s):  
High Myopia ◽  
Case Control ◽  
Laser In Situ Keratomileusis ◽  
Control Analysis ◽  
Case Control Analysis

A case control analysis investigating risk factors and outcomes for nephrocalcinosis and renal calculi in neonates

2017 ◽  
Vol 13 (4) ◽  
pp. 356.e1-356.e5 ◽  
Author(s):  
Melissa Huynh ◽  
Roderick Clark ◽  
Jenny Li ◽  
Guido Filler ◽  
Sumit Dave
Keyword(s):  
Risk Factors ◽  
Renal Calculi ◽  
Case Control ◽  
Control Analysis ◽  
Case Control Analysis

Genetic variants in GTF2H1 and risk of lung cancer: A case–control analysis in a Chinese population

Lung Cancer ◽  
2009 ◽  
Vol 63 (2) ◽  
pp. 180-186 ◽  
Author(s):  
Wenting Wu ◽  
Hongliang Liu ◽  
Rong Lei ◽  
Dan Chen ◽  
Shuyu Zhang ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Genetic Variants ◽  
Chinese Population ◽  
Case Control ◽  
Control Analysis ◽  
Case Control Analysis
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