scholarly journals Risk Factors for Recurrence after Successful Treatment of Mycobacterium avium Complex Lung Disease

2015 ◽  
Vol 59 (6) ◽  
pp. 2972-2977 ◽  
Author(s):  
Bo Young Lee ◽  
Sunyoung Kim ◽  
YoonKi Hong ◽  
Sang-Do Lee ◽  
Woo Sung Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Disease ◽  
Recurrence Rate ◽  
Mycobacterium Avium ◽  
Successful Treatment ◽  
Etiologic Agent ◽  
Content Type ◽  
Tertiary Referral Center ◽  
Increased Risk ◽  
Risk Factors For Recurrence

ABSTRACTThis study analyzed the recurrence rate and risk factors for recurrence ofMycobacterium aviumcomplex (MAC) lung disease in patients successfully treated for this disease. The medical records of 158 patients successfully treated for MAC lung disease at a tertiary referral center in South Korea between March 2000 and December 2009 were retrospectively analyzed. Recurrence was recorded, and factors associated with recurrence were analyzed. The mean age of the 158 patients was 60.7 ± 11.1 years. The etiologic agent wasMycobacterium aviumin 77 patients (48.7%) andMycobacterium intracellularein 81 patients (51.3%). Radiographic features included nodular bronchiectatic disease in 95 (60.1%), fibrocavitary disease in 49 (31.0%), and an unclassifiable form in 14 (8.9%) patients. Almost all (98.7%, 156/158) patients had been previously treated with a macrolide-containing regimen, and 68 (43.0%) patients had received treatment with an aminoglycoside. During a median follow-up of 43.8 months after completion of therapy, 50 patients (31.6%) experienced recurrence, at a median of 11.9 months after treatment completion. Multivariate analysis showed that only the nodular bronchiectatic form of the disease (hazard ratio, 2.39; 95% confidence interval, 1.19 to 4.81) was independently associated with an increased risk of recurrence. Recurrence after successful treatment is frequent in patients with MAC lung disease. The recurrence rate was significantly higher in patients with the nodular bronchiectatic form than in those with the fibrocavitary form or an unclassifiable form of the disease.

scholarly journals Risk Factors Associated with Carbapenemase-Producing Enterobacterales (CPE) Positivity in the Hospital Wastewater Environment

2020 ◽  
Vol 86 (24) ◽  
Author(s):  
Stacy C. Park ◽  
Hardik Parikh ◽  
Kasi Vegesana ◽  
Nicole Stoesser ◽  
Katie E. Barry ◽  
...  
Keyword(s):  
Risk Factors ◽  
Klebsiella Pneumoniae ◽  
Hospital Environment ◽  
Hospital Wastewater ◽  
Content Type ◽  
The Past ◽  
Clostridioides Difficile ◽  
Increased Risk ◽  
Increase Risk ◽  
Gram Negative Organisms

ABSTRACT Hospital wastewater is an increasingly recognized reservoir for resistant Gram-negative organisms. Factors involved in establishment and persistence of Klebsiella pneumoniae carbapenemase-producing organisms (KPCOs) in hospital wastewater plumbing are unclear. This study was conducted at a hospital with endemic KPCOs linked to wastewater reservoirs and robust patient perirectal screening for silent KPCO carriage. Over 5 months, both rooms occupied and rooms not occupied by KPCO-positive patients were sampled at three wastewater sites within each room (sink drain, sink P-trap, and toilet or hopper). Risk factors for KPCO positivity were assessed using logistic regression. Whole-genome sequencing (WGS) identified environmental seeding by KPCO-positive patients. A total of 219/475 (46%) room sampling events were KPCO positive in at least one wastewater site. KPCO-positive patient exposure was associated with increased risk of environmental positivity for the room and toilet/hopper. Previous positivity and intensive care unit room type were consistently associated with increased risk. Tube feeds were associated with increased risk for the drain, while exposure to patients with Clostridioides difficile was associated with decreased risk. Urinary catheter exposure was associated with increased risk of P-trap positivity. P-trap heaters reduced risk of P-trap and sink drain positivity. WGS identified genomically linked environmental seeding in 6 of 99 room occupations by 40 KPCO-positive patients. In conclusion, KPCO-positive patients seed the environment in at least 6% of opportunities; once positive for KPCOs, wastewater sites are at greater risk of being positive subsequently. Increased nutrient exposure, e.g., due to tube food disposal down sinks, may increase risk; frequent flushing may be protective. IMPORTANCE Klebsiella pneumoniae carbapenemase-producing organisms (KPCOs) are bacteria that are resistant to most antibiotics and thus are challenging to treat when they cause infections in patients. These organisms can be acquired by patients who are hospitalized for other reasons, complicating their hospital stay and even leading to death. Hospital wastewater sites, such as sink drains and toilets, have played a role in many reported outbreaks over the past decade. The significance of our research is in identifying risk factors for environmental positivity for KPCOs, which will facilitate further work to prevent transmission of these organisms to patients from the hospital environment.

scholarly journals Risk Factors for Infection or Colonization with CTX-M Extended-Spectrum-β-Lactamase-Positive Escherichia coli

2012 ◽  
Vol 56 (11) ◽  
pp. 5575-5580 ◽  
Author(s):  
Jennifer H. Han ◽  
Kei Kasahara ◽  
Paul H. Edelstein ◽  
Warren B. Bilker ◽  
Ebbing Lautenbach
Keyword(s):  
Risk Factors ◽  
Escherichia Coli ◽  
Control Strategies ◽  
Content Type ◽  
E Coli ◽  
Extended Spectrum ◽  
Increased Risk ◽  
Urinary Culture ◽  
Multivariable Analyses ◽  
And Control

ABSTRACTThere has been a significant increase in the prevalence ofEnterobacteriaceaethat produce CTX-M-type extended-spectrum β-lactamases. The objective of this study was to evaluate risk factors for infection or colonization with CTX-M-positiveEscherichia coli. A case-control study was conducted within a university system from 1 January 2007 to 31 December 2008. All patients with clinical cultures withE. colidemonstrating resistance to extended-spectrum cephalosporins were included. Case patients were designated as those with cultures positive for CTX-M-positiveE. coli, and control patients were designated as those with non-CTX-M-producingE. coli. Multivariable logistic regression analyses were performed to evaluate risk factors for CTX-M-positive isolates. A total of 83 (56.8%) of a total of 146 patients had cultures with CTX-M-positiveE. coli. On multivariable analyses, there was a significant association between infection or colonization with CTX-M-type β-lactamase-positiveE. coliand receipt of piperacillin-tazobactam in the 30 days prior to the culture date (odds ratio [OR], 7.36; 95% confidence interval [CI], 1.61 to 33.8;P= 0.01) and a urinary culture source (OR, 0.36; 95% CI, 0.17 to 0.77;P= 0.008). The rates of resistance to fluoroquinolones were significantly higher in isolates from case patients than in isolates from control patients (90.4 and 50.8%, respectively;P< 0.001). We found that nonurinary sources of clinical cultures and the recent use of piperacillin-tazobactam conferred an increased risk of colonization or infection with CTX-M-positiveE. coli. Future studies will need to focus on outcomes associated with infections due to CTX-M-positiveE. coli, as well as infection control strategies to limit the spread of these increasingly common organisms.

Risk factors for recurrence after successful treatment of warts: the role of smoking habits

2017 ◽  
Vol 31 (4) ◽  
pp. 712-716 ◽  
Author(s):  
P.L. Bencini ◽  
S. Guida ◽  
S. Cazzaniga ◽  
G. Pellacani ◽  
M.G. Galimberti ◽  
...  
Keyword(s):  
Risk Factors ◽  
Successful Treatment ◽  
Smoking Habits ◽  
Risk Factors For Recurrence

scholarly journals Suicide in an ageing UK population: problems and prevention

2016 ◽  
Vol 17 (4) ◽  
pp. 218-228
Author(s):  
Gary Hodge
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Suicide Risk ◽  
Baby Boom ◽  
Later Life ◽  
Cultural Issues ◽  
Content Type ◽  
Increased Risk ◽  
The Social ◽  
Easy Answer

Purpose Suicide can be an emotive, and at times, controversial subject. The purpose of this paper is to reflect on the social, health, personal, and cultural issues that can arise in later life and the potential reasons for suicide. It will analyse already recognised risk factors of suicide in older adults and focus on improving knowledge about the social meaning and causation of suicide for older people. It will also consider suicide prevention policies, their practice implications, and whether they are successful in protecting this potentially vulnerable cohort. Design/methodology/approach A synopsis of available literature in the form of a general review paper of suicide of older adults. Findings There is evidence that the ageing process often leads to a set of co-morbidities and a complex and diverse set of individual challenges. This in turn equates to an increased risk of suicide. There is no easy answer to why there is evidence of a growing number of older adults deciding that suicide is there only option, and even fewer suggestions on how to manage this risk. Social implications The entry of the “baby boom” generation into retirement will lead to the potential of an increase in both suicide risk factors and older adults completing suicide. This is on the background of a demographic surge which is likely to place additional pressures on already under-resourced, and undervalued, statutory and non-statutory services. Originality/value A literature search found very little information regarding older adults and suicide risk, assessment, treatment or prevention.

scholarly journals Risk Factors for Recurrence of Benign Paroxysmal Positional Vertigo. A Clinical Review

2021 ◽  
Vol 10 (19) ◽  
pp. 4372
Author(s):  
Ioanna Sfakianaki ◽  
Paris Binos ◽  
Petros Karkos ◽  
Grigorios G. Dimas ◽  
George Psillas
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Recurrence Rate ◽  
Benign Paroxysmal Positional Vertigo ◽  
Female Gender ◽  
Recurrence Rates ◽  
Positional Vertigo ◽  
Risk Factors For Recurrence ◽  
Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is one of the most common peripheral vestibular dysfunctions encountered in clinical practice. Although the treatment of BPPV is relatively successful, many patients develop recurrence after treatment. Our purpose is to evaluate the mean recurrence rate and risk factors of BPPV after treatment. A review of the literature on the risk factors of BPPV recurrence was performed. A thorough search was conducted using electronic databases, namely Pubmed, CINAHL, Academic Search Complete and Scopus for studies published from 2000 to 2020. Thirty studies were included in this review with 13,358 participants. The recurrence rate of BPPV ranged from 13.7% to 48% for studies with follow-up <1 year, and from 13.3% to 65% for studies with follow-up ≥2 years. Pathophysiologic mechanisms and implication of each of the following risk factors in the recurrence of BPPV were described: advanced age, female gender, Meniere’s disease, trauma, osteopenia or osteoporosis, vitamin D deficiency, diabetes mellitus, hypertension, hyperlipidemia, cardiovascular disease, migraine, bilateral/multicanal BPPV, cervical osteoarthrosis and sleep disorders. Patients with hyperlipidemia and hypertension had the highest recurrence rates of BPPV, 67.80% and 55.89%, respectively, indicating that vascular comorbidities increase the risk of BPPV recurrence. In addition, more than half of patients (53.48%) with diabetes mellitus and BPPV experienced recurrence of BPPV. Knowledge and awareness of risk factors for recurrence of BPPV are essential for the assessment and long-term prognosis of patients. Identification of these relapse risk factors may enhance the ability of clinicians to accurately counsel patients regarding BPPV and associated comorbidities.

scholarly journals Risk Factors For Recurrence of Peptic Ulcer Disease: A Retrospective Study In Tertiary Care Referral Center

2022 ◽  
Author(s):  
Yaser Alsinnari ◽  
Mohammed S. Alqarni ◽  
Meshari Attar ◽  
Ziad M. Bukhari ◽  
Faisal Baabbad ◽  
...  
Keyword(s):  
Risk Factors ◽  
Peptic Ulcer ◽  
Peptic Ulcer Disease ◽  
Recurrence Rate ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Ulcer Disease ◽  
Significant Difference ◽  
Risk Factors For Recurrence ◽  
H Pylori

Abstract Backgrounds: Peptic ulcer disease (PUD) is a common gastrointestinal tract disease characterized by mucosal damage secondary to pepsin and gastric acid secretion. The aim of this study was to evaluate the five-year recurrence rate for treated patients with PUD and risk factors contributing to PUD relapses.Methods: From 2016 through 2021, all patients with endoscopy-proved PUD were identified by reviewing medical records (Best-Care system). Possible risk factors including smoking, non-steroidal anti-inflammatory drugs (NSAIDs), aspirin, alcohol, caffeine, and steroid were analyzed by univariate analysis. Treatment outcomes, 5-year recurrence rate, and mortality rate were assessed.Results: Among 223 patients, there were 187 (83.8%), who diagnosed endoscopy-proved PUD and 36 (16.2%), who diagnosed clinical PUD. Among them, 126 (56.5%) patients were males and the mean age was 62±2 years. The five years recurrence rate of PUD was 30.9%. There was no significant difference in the recurrence rate between the duodenal ulcer (33.3%) and the gastric ulcer (28.8%). By univariate analysis, the use of steroid and NSAID and H. pylori infection were potential risk factors for PUD (P < 0.005). The common complication of PUD was gastrointestinal bleeding (34.1%). Patients who had a complicated PUD were associated with a higher rate of recurrence (45.9%) compared to the uncomplicated PUD (19.2%) (P > 0.05). Conclusion: Our findings demonstrated that the five years recurrence rate of PUD was 30.9%. The use of steroid and NSAID and H. pylori infection were risk factors for recurrence of PUD. PUD places a significant burden on health care systems. Therefore, a multicenter prospective study is needed for effective management to prevent recurrence and complications of PUD.

scholarly journals Impact of Vancomycin MIC on Treatment Outcomes in Invasive Staphylococcus aureus Infections

2016 ◽  
Vol 61 (3) ◽  
Author(s):  
Kyoung-Ho Song ◽  
Moonsuk Kim ◽  
Chung Jong Kim ◽  
Jeong Eun Cho ◽  
Yun Jung Choi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Treatment Outcomes ◽  
Sufficient Evidence ◽  
Current Clinical Practice ◽  
Broth Microdilution ◽  
Content Type ◽  
Increased Risk ◽  
Sterile Site ◽  
The Relationship

ABSTRACT There are conflicting data on the association of vancomycin MIC (VAN-MIC) with treatment outcomes in Staphylococcus aureus infections. We investigated the relationship between high VAN-MIC and 30-day mortality and identified the risk factors for mortality in a large cohort of patients with invasive S. aureus (ISA) infections, defined as the isolation of S. aureus from a normally sterile site. Over a 2-year period, 1,027 adult patients with ISA infections were enrolled in 10 hospitals, including 673 (66%) patients with methicillin-resistant S. aureus (MRSA) infections. There were 200 (19.5%) isolates with high VAN-MIC (≥1.5 mg/liter) by Etest and 87 (8.5%) by broth microdilution (BMD). The all-cause 30-day mortality rate was 27.4%. High VAN-MIC by either method was not associated with all-cause 30-day mortality, and this finding was consistent across MIC methodologies and methicillin susceptibilities. We conclude that high VAN-MIC is not associated with increased risk of all-cause 30-day mortality in ISA infections. Our data support the view that VAN-MIC alone is not sufficient evidence to change current clinical practice.

scholarly journals Characterization of Mouse Models of Mycobacterium avium Complex Infection and Evaluation of Drug Combinations

2015 ◽  
Vol 59 (4) ◽  
pp. 2129-2135 ◽  
Author(s):  
Claire Andréjak ◽  
Deepak V. Almeida ◽  
Sandeep Tyagi ◽  
Paul J. Converse ◽  
Nicole C. Ammerman ◽  
...  
Keyword(s):  
Lung Disease ◽  
Mouse Models ◽  
Mycobacterium Avium ◽  
Treatment Efficacy ◽  
Model Systems ◽  
Mouse Strains ◽  
Combination Drug ◽  
Content Type ◽  
The Impact

ABSTRACTTheMycobacterium aviumcomplex is the most common cause of nontuberculous mycobacterial lung disease worldwide; yet, an optimal treatment regimen forM. aviumcomplex infection has not been established. Clarithromycin is accepted as the cornerstone drug for treatment ofM. aviumlung disease; however, good model systems, especially animal models, are needed to evaluate the most effective companion drugs. We performed a series of experiments to evaluate and use different mouse models (comparing BALB/c, C57BL/6, nude, and beige mice) ofM. aviuminfection and to assess the anti-M. aviumactivity of single and combination drug regimens,in vitro,ex vivo, and in mice.In vitro, clarithromycin and moxifloxacin were most active againstM. avium, and no antagonism was observed between these two drugs. Nude mice were more susceptible toM. aviuminfection than the other mouse strains tested, but the impact of treatment was most clearly seen inM. avium-infected BALB/c mice. The combination of clarithromycin-ethambutol-rifampin was more effective in all infected mice than moxifloxacin-ethambutol-rifampin; the addition of moxifloxacin to the clarithromycin-containing regimen did not increase treatment efficacy. Clarithromycin-containing regimens are the most effective forM. aviuminfection; substitution of moxifloxacin for clarithromycin had a negative impact on treatment efficacy.

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