scholarly journals Prospective Study on Incidence, Risk Factors and Outcome of Recurrent Clostridioides difficile Infections

2021 ◽  
Vol 10 (5) ◽  
pp. 1127
Author(s):  
Guido Granata ◽  
Nicola Petrosillo ◽  
Lucia Adamoli ◽  
Michele Bartoletti ◽  
Alessandro Bartoloni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Incidence Rate ◽  
Case Control Study ◽  
Antimicrobial Treatment ◽  
Clostridioides Difficile ◽  
All Cause Mortality ◽  
Clostridioides Difficile Infection ◽  
Incidence Risk ◽  
Control Study

Background: Limited and wide-ranging data are available on the recurrent Clostridioides difficile infection (rCDI) incidence rate. Methods: We performed a cohort study with the aim to assess the incidence of and risk factors for rCDI. Adult patients with a first CDI, hospitalized in 15 Italian hospitals, were prospectively included and followed-up for 30 d after the end of antimicrobial treatment for their first CDI. A case–control study was performed to identify risk factors associated with 30-day onset rCDI. Results: Three hundred nine patients with a first CDI were included in the study; 32% of the CDI episodes (99/309) were severe/complicated; complete follow-up was available for 288 patients (19 died during the first CDI episode, and 2 were lost during follow-up). At the end of the study, the crude all-cause mortality rate was 10.7% (33 deaths/309 patients). Two hundred seventy-one patients completed the follow-up; rCDI occurred in 21% of patients (56/271) with an incidence rate of 72/10,000 patient-days. Logistic regression analysis identified exposure to cephalosporin as an independent risk factor associated with rCDI (RR: 1.7; 95% CI: 1.1–2.7, p = 0.03). Conclusion: Our study confirms the relevance of rCDI in terms of morbidity and mortality and provides a reliable estimation of its incidence.

scholarly journals Prehospital delay is an important risk factor for mortality in community-acquired bloodstream infection (CA-BSI): a matched case–control study

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e052582
Author(s):  
Martin Holmbom ◽  
Maria Andersson ◽  
Sören Berg ◽  
Dan Eklund ◽  
Pernilla Sobczynski ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Bloodstream Infection ◽  
Case Control Study ◽  
Case Control ◽  
Important Risk Factor ◽  
Retrospective Case ◽  
Prehospital Delay ◽  
All Cause Mortality ◽  
Control Study

ObjectivesThe aim of this study was to identify prehospital and early hospital risk factors associated with 30-day mortality in patients with blood culture-confirmed community-acquired bloodstream infection (CA-BSI) in Sweden.MethodsA retrospective case–control study of 1624 patients with CA-BSI (2015–2016), 195 non-survivors satisfying the inclusion criteria were matched 1:1 with 195 survivors for age, gender and microorganism. All forms of contact with a healthcare provider for symptoms of infection within 7 days prior CA-BSI episode were registered. Logistic regression was used to analyse risk factors for 30-day all-cause mortality.ResultsOf the 390 patients, 61% (115 non-survivors and 121 survivors) sought prehospital contact. The median time from first prehospital contact till hospital admission was 13 hours (6–52) for non-survivors and 7 hours (3–24) for survivors (p<0.01). Several risk factors for 30-day all-cause mortality were identified: prehospital delay OR=1.26 (95% CI: 1.07 to 1.47), p<0.01; severity of illness (Sequential Organ Failure Assessment score) OR=1.60 (95% CI: 1.40 to 1.83), p<0.01; comorbidity score (updated Charlson Index) OR=1.13 (95% CI: 1.05 to 1.22), p<0.01 and inadequate empirical antimicrobial therapy OR=3.92 (95% CI: 1.64 to 9.33), p<0.01. In a multivariable model, prehospital delay >24 hours from first contact remained an important risk factor for 30-day all-cause mortality due to CA-BSI OR=6.17 (95% CI: 2.19 to 17.38), p<0.01.ConclusionPrehospital delay and inappropriate empirical antibiotic therapy were found to be important risk factors for 30-day all-cause mortality associated with CA-BSI. Increased awareness and earlier detection of BSI in prehospital and early hospital care is critical for rapid initiation of adequate management and antibiotic treatment.

scholarly journals Incidence, risk factors and perinatal outcomes for placenta accreta in Australia and New Zealand: a case–control study

BMJ Open ◽  
2017 ◽  
Vol 7 (10) ◽  
pp. e017713 ◽  
Author(s):  
Cynthia M Farquhar ◽  
Zhuoyang Li ◽  
Sarah Lensen ◽  
Claire McLintock ◽  
Wendy Pollock ◽  
...  
Keyword(s):  
Risk Factors ◽  
New Zealand ◽  
Caesarean Section ◽  
Case Control Study ◽  
Placenta Accreta ◽  
Perinatal Outcomes ◽  
Case Control ◽  
Secondary Outcome ◽  
Incidence Risk ◽  
Control Study

ObjectiveEstimate the incidence of placenta accreta and describe risk factors, clinical practice and perinatal outcomes.DesignCase–control study.SettingSites in Australia and New Zealand with at least 50 births per year.ParticipantsCases were women giving birth (≥20 weeks or fetus ≥400 g) who were diagnosed with placenta accreta by antenatal imaging, at operation or by pathology specimens between 2010 and 2012. Controls were two births immediately prior to a case. A total of 295 cases were included and 570 controls.MethodsData were collected using the Australasian Maternity Outcomes Surveillance System.Primary and secondary outcome measuresIncidence, risk factors (eg, prior caesarean section (CS), maternal age) and clinical outcomes of placenta accreta (eg CS, hysterectomy and death).ResultsThe incidence of placenta accreta was 44.2/100 000 women giving birth (95% CI 39.4 to 49.5); however, this may overestimated due to the case definition used. In primiparous women, an increased odds of placenta accreta was observed in older women (adjusted OR (AOR) women≥40 vs <30: 19.1, 95% CI 4.6 to 80.3) and current multiple birth (AOR: 6.1, 95% CI 1.1 to 34.1). In multiparous women, independent risk factors were prior CS (AOR ≥2 prior sections vs 0: 13.8, 95% CI 7.4 to 26.1) and current placenta praevia (AOR: 36.3, 95% CI 14.0 to 93.7). There were two maternal deaths (case fatality rate 0.7%).Women with placenta accreta were more likely to have a caesarean section (AOR: 4.6, 95% CI 2.7 to 7.6) to be admitted to the intensive care unit (ICU)/high dependency unit (AOR: 46.1, 95% CI 22.3 to 95.4) and to have a hysterectomy (AOR: 209.0, 95% CI 19.9 to 875.0). Babies born to women with placenta accreta were more likely to be preterm, be admitted to neonatal ICU and require resuscitation.

Risk Factors for Tuberculosis (TB) Among Household Contacts of Patients With Smear-Positive TB in 8 Provinces of Vietnam: A Nested Case-Control Study

2020 ◽  
Author(s):  
Kavindhran Velen ◽  
Nguyen Viet Nhung ◽  
Nguyen Thu Anh ◽  
Pham Duc Cuong ◽  
Nguyen Binh Hoa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Factors Associated ◽  
Household Contacts ◽  
Key Population ◽  
History Of ◽  
Nested Case Control ◽  
And Control ◽  
Control Study

Abstract Background Tuberculosis (TB) continues to account for significant morbidity and mortality annually. Household contacts (HHCs) of persons with TB are a key population for targeting prevention and control interventions. We aimed to identify risk factors associated with developing TB among HHCs. Methods We conducted a nested case-control study among HHCs in 8 provinces in Vietnam enrolled in a randomized controlled trial of active case finding for TB. Cases were any HHCs diagnosed and registered with TB within the Vietnam National TB Program during 2 years of follow-up. Controls were selected by simple random sampling from the remaining HHCs. Risk factor data were collected at enrollment and during follow-up. A logistic regression model was developed to determine predictors of TB among HHCs. Results We selected 1254 HHCs for the analysis: 214 cases and 1040 controls. Underlying characteristics varied between both groups; cases were older, more likely to be male, with a higher proportion of reported previous TB and diabetes. Risk factors associated with a TB diagnosis included being male (adjusted odds ratio [aOR], 1.4; 95% confidence interval [CI], 1.03–2.0), residing in an urban setting (aOR, 1.8; 1.3–2.5), prior TB (aOR, 4.6; 2.5–8.7), history of diabetes (aOR, 3.1; 1.7–5.8), current smoking (aOR, 3.1; 2.2–4.4), and prolonged history of coughing in the index case at enrollment (OR , 1.6; 1.1–2.3). Conclusions Household contacts remain an important key population for TB prevention and control. TB programs should ensure effective contact investigations are implemented for household contacts, particularly those with additional risk factors for developing TB.

Suicide in recently discharged psychiatric patients: a case-control study

2008 ◽  
Vol 39 (3) ◽  
pp. 443-449 ◽  
Author(s):  
I. M. Hunt ◽  
N. Kapur ◽  
R. Webb ◽  
J. Robinson ◽  
J. Burns ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Suicide Risk ◽  
Case Control Study ◽  
Clinical Symptoms ◽  
Risk Measures ◽  
Psychiatric Patients ◽  
Case Control ◽  
Control Study

BackgroundFew controlled studies have specifically investigated aspects of mental health care in relation to suicide risk among recently discharged psychiatric patients. We aimed to identify risk factors, including variation in healthcare received, for suicide within 3 months of discharge.MethodWe conducted a national population-based case-control study of 238 psychiatric patients dying by suicide within 3 months of hospital discharge, matched on date of discharge to 238 living controls.ResultsForty-three per cent of suicides occurred within a month of discharge, 47% of whom died before their first follow-up appointment. The first week and the first day after discharge were particular high-risk periods. Risk factors for suicide included a history of self-harm, a primary diagnosis of affective disorder, recent last contact with services and expressing clinical symptoms at last contact with staff. Suicide cases were more likely to have initiated their own discharge and to have missed their last appointment with services. Patients who were detained for compulsory treatment at last admission, or who were subject to enhanced levels of aftercare, were less likely to die by suicide.ConclusionsThe weeks after discharge from psychiatric care represent a critical period for suicide risk. Measures that could reduce risk include intensive and early community follow-up. Assessment of risk should include established risk factors as well as current mental state and there should be clear follow-up procedures for those who have self-discharged. Recent detention under the Mental Health Act and current use of enhanced levels of aftercare may be protective.

scholarly journals Polygenic Risk Score in Follicular Lymphoma Risk and Prognosis in a Population-Based Case-Control Study in Los Angeles County

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2296-2296
Author(s):  
Charlie Zhong ◽  
Jianning Luo ◽  
Chun R Chao ◽  
Susan Neuhausen ◽  
Joo Y. Song ◽  
...  
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Los Angeles ◽  
Genetic Risk ◽  
Los Angeles County ◽  
Case Control Study ◽  
Case Control ◽  
Risk Alleles ◽  
Control Study

Abstract Background: Although several prognostic factors are regularly utilized for follicular lymphoma (FL) - e.g., extent of disease, presence of B-symptoms, and the FL international prognostic index (IPI) - they do not fully account for the heterogeneity in patient outcomes. Etiologic risk factors may influence the heterogeneity of prognostic outcomes, but relatively few risk factors for FL have been identified and subsequently confirmed. Recent epidemiologic studies have uncovered genetic risk loci associated with FL risk. To date, the association between these risk alleles with FL prognosis remains unknown. We therefore sought to evaluate whether identified genetic risk loci specific to FL also play a role in FL prognosis. Methods: We previously conducted a population-based case-control study of primary, incident Non-Hodgkin Lymphoma (NHL) among women in Los Angeles County diagnosed from 2006 to 2009. A total of 230 FL cases were enrolled in the study along with 246 age- and race- matched controls. To ascertain treatment and follow-up information, medical records were retrieved and abstracted, and data linkages to the California hospitalization discharge records and SEER-Medicare were conducted. Based on abstracted data, we constructed a surrogate to the FL IPI. Genotyping for FL genetic risk alleles identified in the National Human Genome Research Institute-European Bioinformatics Institute genome wide association study catalog (rs12195582, rs13254990, rs17749561, rs4245081, and rs4938573) was conducted and used to construct a polygenic risk score (PRS). The PRS was computed by taking a weighted average of the five alleles and the log of their reported odds ratio and creating tertiles based on the values of our control. To confirm the risk association, we first evaluated the association between our PRS and FL risk, adjusted for demographic characteristics and potential confounders (e.g., smoking status, BMI, and family history of hematologic malignancies). We subsequently confirmed the prognostic performance of our reconstructed IPI and then evaluated the association between the PRS and FL outcomes, including overall survival (OS), defined as date of initial diagnosis to date of death or last known follow-up; and event-free survival at 12 months (EFS12) and 24 months (EFS24), where events consisted of progression, refractory disease, or death. Results: In case-control analysis, we confirmed an increased FL risk associated with the third tertile PRS (OR=2.19, 95% CI=1.22-3.94), compared to the first tertile. The median follow-up time among FL cases was 8.5 years (IQR: 7.1-10.1) after initial diagnosis: 50 (22%) FL cases had died, 198 (86%) achieved EFS12 and 186 (81%) achieved EFS24. The re-constructed FL-IPI in our case population was statistically significantly associated with overall survival (HR=4.00, 95% CI=1.32-12.16). In our multivariate model that included the PRS, we observed a marginally significant risk for longer overall survival (HR=0.39, 95% CI=0.15, 1.01), but no association with EFS12 or EFS24. No statistically significant associations of individual risk alleles and prognostic outcomes were observed. Race-specific results and evaluation of demographic and other risk factors on risk and survival will also be presented in relation to the PRS. Conclusion: In our population sample of FL cases identified from the Los Angeles County Cancer Registry and initially recruited for a case-control study, we confirmed the association between a PRS and FL risk. We further report a potential association between the PRS and improved overall survival, suggesting an opposite effect for the PRS on risk versus survival. Larger studies on FL with genetic data and prognostic outcomes are warranted to replicate this finding. Disclosures Chao: Seattle Genetics: Research Funding.

Risk factors and outcomes of management of delayed suprachoroidal haemorrhage following Ahmed glaucoma valve implantation in children

2019 ◽  
Vol 104 (1) ◽  
pp. 115-120 ◽  
Author(s):  
Shantha Balekudaru ◽  
Tamonash Basu ◽  
Parveen Sen ◽  
Pramod Bhende ◽  
Vijaya Lingam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Univariate Analysis ◽  
Congenital Glaucoma ◽  
Ahmed Glaucoma Valve ◽  
Retrospective Case ◽  
Incidence Risk ◽  
Valve Implantation ◽  
Ahmed Glaucoma Valve Implantation ◽  
Control Study

AimsTo assess the incidence, risk factors and outcomes of management of delayed suprachoroidal haemorrhage (DSCH) in children who had undergone Ahmed glaucoma valve implantation.MethodsA retrospective case-control study of eyes which developed DSCH in children <18 years of age who underwent surgery between January 2009 and December 2017 with a follow-up of at least 2 months was performed. Nine cases were compared with 27 age, gender and surgeon matched controls who had undergone surgery during this period.ResultsThe incidence of DSCH was 4.7% (95% CL 1.5% to 7.7%, 9 eyes of 191 children). There were no significant differences between cases and controls in baseline details except for the number of intraocular pressure (IOP) lowering medications (p=0.01) and follow-up period (p=0.001). Risk factors identified on univariate analysis (p≤0.1) were axial length (p=0.02), diagnosis of primary congenital glaucoma (p=0.05), postoperative hypotony (p=0.07) and aphakia (p=0.1). None of them were found to be significant on multivariate analysis. Five eyes, three with retinal apposition and two with retinal detachment, underwent surgical drainage. There were no significant differences in the outcomes of eyes which underwent drainage compared with those which did not. Failures, defined as IOP>18 mm Hg despite use of medications, loss of light perception, phthisis or removal of the implant were more frequent in cases (three eyes, 33.3%) compared with controls (four eyes, 14.8%) (p=0.002).ConclusionsNone of the risk factors analysed in our series proved to be significant. Failures were more common in eyes with choroidal haemorrhage, despite surgical intervention.

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