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 Sequential Measurements of Pentraxin 3 Serum Levels in Patients with Ventilator-Associated Pneumonia: A Nested Case-Control Study

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Huseyin Bilgin ◽  
Murat Haliloglu ◽  
Ali Yaman ◽  
Pinar Ay ◽  
Beliz Bilgili ◽  
...  
Keyword(s):  
Predictive Value ◽  
Case Control Study ◽  
Tertiary Care ◽  
Case Control ◽  
Surgical Intensive Care Unit ◽  
Ventilator Associated Pneumonia ◽  
Pentraxin 3 ◽  
Surgical Intensive Care ◽  
Nested Case Control ◽  
Control Study

Purpose. The main purpose of this study was to investigate the dynamics of pentraxin 3 (PTX3) compared with procalcitonin (PCT) and C-reactive protein (CRP) in patients with suspicion of ventilator-associated pneumonia (VAP). Materials and Methods. We designed a nested case-control study. This study was performed in the Surgical Intensive Care Unit of a tertiary care academic university and teaching hospital. Ninety-one adults who were mechanically ventilated for >48 hours were enrolled in the study. VAP diagnosis was established among 28 patients following the 2005 ATS/IDSA guidelines. Results. The median PTX3 plasma level was 2.66 ng/mL in VAP adults compared to 0.25 ng/mL in non-VAP adults (p<0.05). Procalcitonin and CRP levels did not significantly differ. Pentraxin 3, with a 2.56 ng/mL breakpoint, had 85% sensitivity, 86% specificity, 75% positive predictive value, and 92.9% negative predictive value for VAP diagnosis (AUC = 0.78). Conclusions. With the suspicion of VAP, a pentraxin 3 plasma breakpoint of 2.56 ng/mL could contribute to the decision of whether to start antibiotics.

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.

scholarly journals Risk Factors for Postpartum Hemorrhage in a Thai–Myanmar Border Community Hospital: A Nested Case-Control Study

2021 ◽  
Vol 18 (9) ◽  
pp. 4633
Author(s):  
Waraporn Thepampan ◽  
Nuchsara Eungapithum ◽  
Krittai Tanasombatkul ◽  
Phichayut Phinyo
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Postpartum Hemorrhage ◽  
Minority Groups ◽  
Case Control Study ◽  
Community Hospital ◽  
Case Control ◽  
Border Community ◽  
Nested Case Control ◽  
Control Study

Postpartum hemorrhage (PPH) is a common complication of pregnancy and a global public health concern. Even though PPH risk factors were extensively studied and reported in literature, almost all studies were conducted in non-Asian countries or tertiary care centers. Our study aimed to explore relevant risk factors for PPH among pregnant women who underwent transvaginal delivery at a Thai–Myanmar border community hospital in Northern Thailand. An exploratory nested case-control study was conducted to explore risk factors for PPH. Women who delivered transvaginal births at Maesai hospital from 2014 to 2018 were included. Two PPH definitions were used, which were ≥ 500 mL and 1000 mL of estimated blood loss within 24 h after delivery. Multivariable conditional logistic regression was used to identify significant risk factors for PPH and severe PPH. Of 4774 women with vaginal births, there were 265 (5.55%) PPH cases. Eight factors were identified as independent predictors for PPH and severe PPH: elderly pregnancy, minority groups, nulliparous, previous PPH history, BMI ≥ 35 kg/m2, requiring manual removal of placenta, labor augmentation, and fetal weight > 4000 gm. Apart from clinical factors, particular attention should be given to pregnant women who were minority groups as PPH risk significantly increased in this population.

scholarly journals 172. Risk Factors for 30-Day Mortality in Patients with Staphylococcus aureus Bacteremia at a Community Hospital: A Prospective Case–Control Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S109-S110
Author(s):  
Charles Hoffmann ◽  
Gordon Watkins ◽  
Patrick DeSimone ◽  
Peter Hallisey ◽  
David Hutchinson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Case Control Study ◽  
Community Hospital ◽  
Univariate Analysis ◽  
Case Control ◽  
Blood Cultures ◽  
Staphylococcus Aureus Bacteremia ◽  
Initial Blood ◽  
Control Study

Abstract Background Staphylococcus aureus bacteremia (SAB) is associated with 30-day all-cause mortality rates approaching 20–30%. The purpose of this case–control study was to evaluate risk factors for 30-day mortality in patients with SAB at a community hospital. Methods As part of an antimicrobial stewardship program (ASP) initiative mandating Infectious Diseases consultation for episodes of SAB, our ASP prospectively monitored all cases of SAB at a 341-bed community hospital in Jefferson Hills, PA from April 2017–February 2019. Cases included patients with 30-day mortality from the initial positive blood culture. Only the first episode of SAB was included; patients were excluded if a treatment plan was not established (e.g., left against medical advice). Patient demographics, comorbidities, laboratory results, and clinical management of SAB were evaluated. Inferential statistics were used to analyze risk factors associated with 30-day mortality. Results 100 patients with SAB were included; 18 (18%) experienced 30-day mortality. Cases were older (median age 76.5 vs. 64 years, P < 0.001), more likely to be located in the intensive care unit (ICU) at time of ASP review (55.6% vs. 30.5%, P = 0.043), and less likely to have initial blood cultures obtained in the emergency department (ED) (38.9% vs. 80.5%, P < 0.001). Variables associated with significantly higher odds for 30-day mortality in univariate analysis: older age, location in ICU at time of ASP review, initial blood cultures obtained at a location other than the ED, and total Charlson Comorbidity Index (CCI). Variables with P < 0.2 on univariate analysis were analyzed via multivariate logistic regression (Table 1). Conclusion Results show that bacteremia due to MRSA and total CCI were not significantly associated with 30-day mortality in SAB, whereas older age was identified as a risk factor. Patients with initial blood cultures obtained at a location other than the ED were at increased odds for 30-day mortality on univariate analysis, which may raise concern for delayed diagnosis. Disclosures All authors: No reported disclosures.

scholarly journals Outbreak ofTsukamurellaSpecies Bloodstream Infection among Patients at an Oncology Clinic, West Virginia, 2011–2012

2014 ◽  
Vol 35 (3) ◽  
pp. 300-306 ◽  
Author(s):  
Isaac See ◽  
Duc B. Nguyen ◽  
Somu Chatterjee ◽  
Thein Shwe ◽  
Melissa Scott ◽  
...  
Keyword(s):  
Infection Control ◽  
Bloodstream Infection ◽  
Case Control Study ◽  
Significant Risk ◽  
Bloodstream Infections ◽  
Case Control ◽  
Control Measures ◽  
Multiple Infection ◽  
Common Source ◽  
Control Study

Objective.To determine the source and identify control measures of an outbreak ofTsukamurellaspecies bloodstream infections at an outpatient oncology facility.Design.Epidemiologic investigation of the outbreak with a case-control study.Methods.A case was an infection in whichTsukamurellaspecies was isolated from a blood or catheter tip culture during the period January 2011 through June 2012 from a patient of the oncology clinic. Laboratory records of area hospitals and patient charts were reviewed. A case-control study was conducted among clinic patients to identify risk factors forTsukamurellaspecies bloodstream infection. Clinic staff were interviewed, and infection control practices were assessed.Results.Fifteen cases ofTsukamurella (Tsukamurella pulmonisorTsukamurella tyrosinosolvens) bloodstream infection were identified, all in patients with underlying malignancy and indwelling central lines. The median age of case patients was 68 years; 47% were male. The only significant risk factor for infection was receipt of saline flush from the clinic during the period September–October 2011 (P= .03), when the clinic had been preparing saline flush from a common-source bag of saline. Other infection control deficiencies that were identified at the clinic included suboptimal procedures for central line access and preparation of chemotherapy.Conclusion.Although multiple infection control lapses were identified, the outbreak was likely caused by improper preparation of saline flush syringes by the clinic. The outbreak demonstrates that bloodstream infections among oncology patients can result from improper infection control practices and highlights the critical need for increased attention to and oversight of infection control in outpatient oncology settings.

scholarly journals The Emergence ofClostridium difficileInfection among Peripartum Women: A Case-Control Study of aC. difficileOutbreak on an Obstetrical Service

2011 ◽  
Vol 2011 ◽  
pp. 1-8 ◽  
Author(s):  
Jennifer A. Unger ◽  
Estella Whimbey ◽  
Michael G. Gravett ◽  
David A. Eschenbach
Keyword(s):  
Infection Control ◽  
Case Control Study ◽  
Clinical Manifestations ◽  
Antibiotic Use ◽  
Case Control ◽  
Control Measures ◽  
Multiple Infection ◽  
Infection Control Measures ◽  
Significant Independent Risk Factor ◽  
Control Study

Objective. An outbreak of 20 peripartumClostridium difficileinfections (CDI) occurred on the obstetrical service at the University of Washington Medical Center (UWMC) between April 2006 and June 2007. In this report, we characterize the clinical manifestations, describe interventions that appeared to reduce CDI, and determine potential risk factors for peripartum CDI.Methods. An investigation was initiated after the first three peripartum CDI cases. Based on the findings, enhanced infection control measures and a modified antibiotic regimen were implemented. We conducted a case-control study of peripartum cases and unmatched controls.Results. During the outbreak, there was an overall incidence of 7.5 CDI cases per 1000 deliveries. Peripartum CDI infection compared to controls was significantly associated with cesarean delivery (70% versus 34%;P=0.03), antibiotic use (95% versus 56%;P=0.001), chorioamnionitis (35% versus 5%;P=0.001), and the use of the combination of ampicillin, gentamicin, and clindamycin (50% versus 3%;P<0.001). Use of combination antibiotics remained a significant independent risk factor for CDI in the multivariate analysis.Conclusions. The outbreak was reduced after the implementation of multiple infection control measures and modification of antibiotic use. However, sporadic CDI continued for 8 months after these measures slowed the outbreak. Peripartum women appear to be another population susceptible to CDI.

Burkholderia cepaciaLower Respiratory Tract Infection Associated With Exposure to a Respiratory Therapist

2001 ◽  
Vol 22 (7) ◽  
pp. 423-426 ◽  
Author(s):  
Alan H. Ramsey ◽  
Patrice Skonieczny ◽  
Diane T. Coolidge ◽  
Terry A. Kurzynski ◽  
Mary E. Proctor ◽  
...  
Keyword(s):  
Intensive Care ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Infection Control ◽  
Respiratory Tract Infection ◽  
Case Control Study ◽  
Respiratory Therapy ◽  
Case Control ◽  
Respiratory Therapist ◽  
Control Study

AbstractObjective:To investigate and control a nosocomial outbreak ofBurkholderia cepacialower respiratory tract infection.Design:Outbreak investigation and case-control study.Setting:A 260-bed community hospital.Patients:Participants were mechanically ventilated intensive care patients without cystic fibrosis. A case was defined as a hospitalized patient with a sputum culture positive forB cepaciabetween January 1 and November 6, 1998.Methods:Respiratory therapy infection control policies and practices were reviewed; laboratory and environmental studies and a retrospective case-control study were conducted. Case-patients were matched with control-patients on age, gender, diagnosis, and type of intensive care unit.Results:Nine case-patients were identified;B cepacialikely caused pneumonia in seven and colonization in two. Two respiratory therapy practices probably contributed to the transmission ofB cepacia:multidose albuterol vials were used among several patients, and nebulizer assemblies often were not dried between uses.B cepaciawas grown from cultures of three previously opened multidose vials; pulsed-field gel electrophoresis patterns ofB cepaciafrom seven case-patients and two multidose vials were indistinguishable. Case-patients had longer durations of heated humidified mechanical ventilation (mean, 9.8 days vs 4.4 days;P=.03) and were more likely to have exposure to one particular respiratory therapist than controls (odds ratio, undefined; 95% confidence interval, 4.7-∞P=.001). The association with the respiratory therapist, a temporary employee, persisted after controlling for duration of heated humidified ventilation. No newB cepaciainfections were identified after control measures were implemented.Conclusions:B cepaciaprobably was transmitted among patients through use of extrinsically contaminated multidose albuterol vials. Respiratory therapy departments must pay close attention to infection control practices, particularly among new or temporary staff.

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