Independent Risk Factors For Infection Research Articles

Risk Factors for Infectious Complications following Endoscopic Retrograde Cholangiopancreatography in Liver Transplant Patients: A Single-Center Study.

Background: Liver transplant recipients often require endoscopic retrograde cholangiopancreatography (ERCP) for biliary complications, which can lead to infections. This retrospective single-center study aimed to identify risk factors for infectious complications following ERCP in liver transplant patients. Methods: A retrospective analysis was conducted on 285 elective ERCP interventions performed in 88 liver transplant patients at a tertiary care center. The primary endpoint was the occurrence of an infection following ERCP. Univariable and multivariable regression analyses, Cox regression, and log-rank tests were employed to assess the influence of various factors on the incidence of infectious complications. Results: Among the 285 ERCP interventions, isolated anastomotic stenosis was found in 175 cases, ischemic type biliary lesion (ITBL) in 103 cases, and choledocholithiasis in seven cases. Bile duct interventions were performed in 96.9% of all ERCPs. Infections after ERCP occurred in 46 cases (16.1%). Independent risk factors for infection included male sex (OR 24.19), prednisolone therapy (OR 4.5), ITBL (OR 4.51), sphincterotomy (OR 2.44), cholangioscopy (OR 3.22), dilatation therapy of the bile ducts (OR 9.48), and delayed prophylactic antibiotic therapy (>1 h after ERCP) (OR 2.93). Additionally, infections following previous ERCP interventions were associated with an increased incidence of infections following future ERCP interventions (p < 0.0001). Conclusion: In liver transplant patients undergoing ERCP, male sex, prednisolone therapy, and complex bile duct interventions independently raised infection risks. Delayed antibiotic treatment further increased this risk. Patients with ITBL were notably susceptible due to incomplete drainage. Additionally, a history of post-ERCP infections signaled higher future risks, necessitating close monitoring and timely antibiotic prophylaxis.

The clinical characteristics, gene mutations and outcomes of myelodysplastic syndromes with diabetes mellitus

PurposeDiabetes mellitus (DM) is the second most common comorbidity in myelodysplastic syndromes (MDS). The purpose of the study was to investigate the clinical characteristics of MDS patients with DM.MethodsA retrospective analysis was performed on the clinical data of 890 MDS patients with or without DM. Clinical data, including genetic changes, overall survival (OS), leukemia-free survival (LFS) and infection, were analyzed.ResultsAmong 890 patients, 184 (20.7%) had DM. TET2 and SF3B1 mutations occurred more frequently in the DM group than those in the non-DM group (p = 0.0092 and p = 0.0004, respectively). Besides, DM was an independent risk factor for infection (HR 2.135 CI 1.451–3.110, p = 0.000) in MDS. Compared to non-DM patients, MDS patients with DM had poor OS and LFS (p = 0.0002 and p = 0.0017, respectively), especially in the lower-risk group. While in multivariate analysis, DM did not retain its prognostic significance and the prognostic significance of infection was maintained (HR 2.488 CI 1.749–3.538, p = 0.000).ConclusionsMDS patients with DM have an inferior prognosis which may due to higher infection incidence, with TET2 and SF3B1 mutations being more frequent in those cases.

Factors influencing delayed high-dose methotrexate excretion and its correlation with adverse reactions after treatment in children with malignant hematological tumors.

High-dose methotrexate (HDMTX) is crucial in treating pediatric malignant hematological tumors. However, its use is often complicated by delayed excretion and associated adverse reactions, which can significantly affect treatment outcomes and patient safety. Identifying risk factors is essential for safer, more effective therapy. This study aimed to investigate the influencing factors for delayed excretion and their correlation with adverse reactions in children with malignant hematological tumors after receiving HDMTX chemotherapy. From April to October 2021, the clinical information of children who had undergone HDMTX chemotherapy and had their blood tested for drug concentration was gathered by the Department of Hematology and Oncology at Shanghai Children's Medical Center. Via univariate and multivariate logistic regression, the factors affecting the delayed excretion of HDMTX were examined, and the relationship between delayed excretion and unfavorable effects in children was determined. This study included 99 patients comprising 199 courses of HDMTX. The occurrence rate of HDMTX delayed excretion was 20.1%. Age ≥9 years and a 24-hour methotrexate (MTX) concentration of 64 µmol/L were independent risk factors for delayed MTX excretion according to multivariate logistic regression analysis (P<0.05). Negative side effects, such as fever, infection, mucositis, gastrointestinal response, and decreased platelet count in children with delayed excretion were statistically significant when compared to those of children with normal excretion. White blood cell reduction, hemoglobin levels below 65 g/L, MTX excretion delay, and concomitant etoposide treatment were all independent risk factors for infection in children. To estimate the risk of delayed MTX excretion during HDMTX therapy, patient laboratory data should be scrutinized, especially for patients ≥9 years or those with a 24-hour MTX concentration of greater than 64 µmol/L.

Cardiac Device Therapy in Patients with Chronic Kidney Disease: An Update.

Cardiovascular diseases (CVDs) and chronic kidney disease (CKD) are frequently interconnected and their association leads to an exponential increase in the risk of both fatal and non-fatal events. In addition, the burden of arrhythmias in CKD patients is increased. On the other hand, the presence of CKD is an important factor that influences the decision to pursue cardiac device therapy. Data on CKD patients with device therapy are scarce and mostly derives from observational studies and case reports. Cardiac resynchronization therapy (CRT) is associated with decreased mortality, reduced heart failure symptoms, and improved renal function in early stages of CKD. Implantable cardioverter defibrillators (ICDs) are associated with a significant reduction in the mortality of CKD patients only for the secondary prevention of sudden cardiac death. Cardiac resynchronization therapy with defibrillator (CRT-D) is preferred in patients who meet the established criteria. The need for cardiac pacing is increased three-fold in dialysis patients. CKD is an independent risk factor for infections associated with cardiac devices.

Profiling risk factors for separation of infection complications in patients with gastrointestinal and nodal diffuse large B-cell lymphoma

ObjectiveTo identify risk factors for infection complications in patients with gastrointestinal diffuse large B-cell lymphoma (GI-DLBCL) and nodal DLBCL (N-DLBCL) during treatment, respectively.MethodsTotal 51 GI-DLBCL patients and 80 N-DLBCL patients were included after retrieving clinical data from a single medical center in the past ten years. Logistic regression analysis was utilized to analyze patients’ data, including baseline demographics, treatments and laboratory values, to determine independent risk factors of infection in these patients.ResultsTotal 28 of 51 patients (54.9%) in the GI-DLBCL group and 52 of 80 patients (65%) in the N-DLBCL group were observed infection events during treatment. A multivariate logistic regression model revealed that Ann-arbor stage IV (P = 0.034; odds ratio [OR]: 10.635; 95% confidence interval [CI]: 1.152-142.712), extra-nodal lesions ≥ 2 (P = 0.041; OR: 23.116; 95%CI: 1.144-466.949) and high serum lactate dehydrogenase (LDH) at the time of diagnosis (LDH > 252U/L; P = 0.033; OR: 6.058; 95%CI: 1.159–31.659) were independent risk factors for the development of infection in patients with GI-DLBCL after systemic treatment. In the N-DLBCL group, high serum C-reactive protein (CRP) (P = 0.027; OR: 1.104; 95%CI: 1.011–1.204) and a low platelet count (P = 0.041; OR: 0.991; 95%CI: 0.982-1.000) at routine blood tests just before infection occurred were identified as significant risk factors related to infection events during treatment.ConclusionsDiscordant independent risk factors induced infection may be present during the treatment in patients with GI-DLBCL and N-DLBCL. Close monitoring these risk factors is likely an effective strategy to prevent microbial infections in these patients.

Establishment and Validation of Models for the Risk of Multi-Drug Resistant Bacteria Infection and Prognosis in Elderly Patients with Pulmonary Infection: A Multicenter Retrospective Study.

The aim of this study was to establish risk prediction and prognosis models for multidrug-resistant bacterial infections (MDRB) in elderly patients with pulmonary infections in a multicenter setting. This study is a retrospective cohort analysis in Anhui province of China. Data dimension reduction and feature selection were performed using the lasso regression model. Multifactorial regression analysis to identify risk factors associated with MDRB infection and prognosis. The relevant risks of each patient in the prognostic training cohort were scored based on prognostic independent risk factors. Subsequently, patients were classified into high-risk and low-risk groups, and survival differences were compared between them. Finally, models were established based on independent risk factors for infection, risk groups, and independent prognostic factors, and were presented on nomograms. The predictive accuracy of the model was assessed using corresponding external validation set data. The study cohort comprised 994 elderly patients with pulmonary infection. Multivariate analysis revealed that endotracheal intubation, previous antibiotic use beyond 2 weeks, and concurrent respiratory failure or cerebrovascular disease were independent risk factors associated with the incidence of MDRB infection. Cox regression analysis identified respiratory failure, malnutrition, an APACHE II score of at least 20, and higher blood creatinine levels as independent prognostic risk factors. The models were validated using an external validation dataset from multiple centers, which demonstrated good diagnostic ability and a good fit with a fair benefit. In conclusion, our study provides an appropriate and generalisable assessment of risk factors affecting infection and prognosis in patients with MDRB, contributing to improved early identification of patients at higher risk of infection and death, and appropriately guiding clinical management.

Foot and Ankle Surgery Postoperative Complications with Regional vs General Anesthesia

Category: Trauma; Other Introduction/Purpose: Regional anesthesia has been increasingly used within orthopaedic surgery. It has been found to decrease opioid use and consumption and has been associated with decreased blood loss and clot formation in some lower extremity surgeries – specifically hip and knee arthroplasty surgery. General anesthesia is not without risks including malignant hyperthermia, laryngeal edema, vocal cord trauma, and delirium. This has led to increased utilization of regional anesthesia in foot and ankle surgery. However, there is a paucity of research that compares the postoperative outcomes in patients treated with regional compared to general anesthesia in these surgeries. We hypothesize the use of regional anesthesia in foot and ankle surgery leads to fewer short-term postoperative complications compared to general anesthesia. Methods: The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database was queried from 2006-2018 to identify patients undergoing foot and ankle surgery. Current Procedural Terminology (CPT) codes for all foot and ankle surgery were utilized to determine which participants to include in the analysis. The cohort was divided into patients who received regional anesthesia versus those who received general anesthesia, and comparisons were made on demographic characteristics, and comorbidities, using chi-squared and t-test analyses. Multivariate logistic regressions were performed to identify whether lack of regional anesthesia was an independent risk factor for infection, minor postoperative complications, and major postoperative complications. Major postoperative complications included any complication that had a long-term effect on someone’s life or led to reoperation, while minor postoperative complications included any event that needed medical intervention but did not impact a person’s health long-term. Results: Using the ACS-NSQIP database and CPT codes, there were 12,764 participants for regional anesthesia and 73,481 participants who had general anesthesia. Utilizing logistic regression, this study found that the absence of regional anesthesia was independently associated with an increased risk for minor complications in foot and ankle surgery (Odds Ratio (OR) 1.34, 95% Confidence Interval (CI) [1.25-1.44], p=0.00). The absence of regional anesthesia was not associated with increased risk of major complications in foot and ankle surgery (OR 1.04, CI [0.96-1.12], p=0.32). Patients who received regional anesthesia were older and had more comorbidities than those without regional anesthesia used which may be a reason for the findings for major complications. Conclusion: Regional anesthesia independently reduced the risk of minor postoperative complications up to 30-days following foot and ankle surgery in this study. Patients undergoing foot and ankle surgery may benefit from augmenting their anesthetic plan with regional anesthesia.

Increased Incidence and Risk Factors of Infections by Extended-Spectrum β-Lactamase-Producing Enterobacterales During the COVID-19 Pandemic: A Retrospective Case-Control Study.

To investigate changes in the incidence of infections by extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) and analyzed whether there was an association between endogenous changes in the organism due to COVID-19 infection and the infections by ESBL-E. The study was a single-center retrospective case-control design. A total of 107 patients infected by ESBL-E during the COVID-19 pandemic were selected as the case group, while 214 uninfected patients selected by 1:2 propensity score matching (PSM) acted as the control group. Univariate analysis, LASSO logistic regression, and multivariate logistic regression were used to determine the risk factors for ESBL-E infection. An interrupted time series was used to analyze the changes in the incidence of ESBL-E infections in hospitalized patients during the COVID-19 pandemic. The incidence of infection with ESBL-E showed a significant increase during COVID-19 (3.42 vs 4.92 per 1000 patients, p = 0.003). The incidence of ESBL-E infections increased at an average rate of 0.45 per 1000 patients per week compared to the pre-pandemic period (p = 0.022). Multivariate logistic regression analysis showed that a length of hospitalization ≥ 15 days (OR: 2.98 (1.07-8.28), chronic kidney disease (OR: 4.25 (1.32-13.70), white blood cell (WBC) > 9.5×10^9/L (OR: 3.04 (1.54-6.01), use of hormonal drugs (OR: 2.38 (1.04-5.43), antibacterial drug use 1 type (OR: 5.38 (2.04-14.21), antibacterial drug use 2 types (OR: 23.05 (6.71-79.25) and antibacterial drug use ≥ 3 types (OR: 88.35 (8.55-912.63) were independent risk factors for infection with ESBL-E, while chronic obstructive pulmonary disease (COPD) was a protective factor (OR: 0.14 (0.03-0.66). COVID-19 was not an independent risk factor for infection by ESBL-E. During the COVID-19 pandemic, the incidence of infections by ESBL-E increased significantly. Increased exposure to traditional risk factors were the main reasons, however, COVID-19 was not an independent risk factor for ESBL-E infection.

The factors predicting development of serious infections in ANCA-associated vasculitis.

Anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a rare autoimmune disease usually involving small vessels and progressing with necrotizing inflammation. Treatment requires long-term use of immunosuppressive agents to inhibit disease activity. Serious infections (SIs) are a common complication in AAV. The aim of this study was to identify the risk factors for serious infections which required hospitalization in patients with AAV. In this retrospective cohort study., we included 84 patients admitted to the Ankara University Faculty of Medicine in the last 10 years with a diagnosis of AAV. In 42 (50%) of 84 patients followed up with the diagnosis of AAV, an infection requiring hospitalization was identified. The patients' total corticosteroid dose, use of pulse steroids, induction regimen, levels of C-reactive protein (CRP) and the presence of pulmonary and renopulmonary involvement were found to be associated with the frequency of infection (p=0.015, p=0.016, p=0.010, p=0.03, p= 0.026 and p=0.029, respectively). In multivariable analysis, it was found that renopulmonary involvement (p=0.002, HR=4.95, 95% CI= 1.804-13.605), age of over 65 (p=0.049, HR=3.37, 95% CI=1.004-11.369) and high CRP levels (p=0.043, HR=1.006, 95% CI=1.000-1.011) constituted independent predictors of serious infection risk. The frequency of infection is known to be increased in ANCA-associated vasculitis. Our study showed that renopulmonary involvement, age and elevated CRP levels on admission are independent risk factors of infection.

Chronic steroid use as a risk factor for postoperative complications following arthroscopic rotator cuff repair

Steroids are a common treatment for many rheumatologic and inflammatory disorders. Chronic steroid use has been studied in joint arthroplasty and arthroscopy, but studies specifically on preoperative chronic steroid use in arthroscopic rotator cuff repair (aRCR) are limited. The purpose of this study is to determine the association between chronic steroid use and 30-day postoperative outcomes following aRCR. The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) was queried to identify all patients who underwent aRCR between 2015 and 2020. Patients were divided into 2 cohorts: nonsteroid users and chronic steroid users. Univariate binomial regression analysis was used to compare demographics, comorbidities, and postoperative outcomes between cohorts. Multivariate regression analysis, adjusted for all significant demographics and comorbidities, was used to identify significant 30-day postoperative outcomes. A total of 39,876 patients remained after exclusion criteria, with 39,068 (97.97%) in the nonsteroid group and 808 (2.02%) in the chronic steroid group. Patient demographics and comorbidities significantly associated with chronic steroid use were age ≥65 (P<.001), female gender (P<.001), body mass index (BMI) ≥35, American Society of Anesthesiologists (ASA) ≥3 (P<.001), dependent functional status (P<.001), nonsmokers (P=.046), higher rates of dyspnea (P<.001), chronic obstructive pulmonary disease (COPD) (P<.001), congestive heart failure (P<.001), hypertension requiring medication (P<.001), open wound infection (P=.018), unintentional weight loss (P<.001), bleeding disorders (P<.001), and inpatient procedure (P=.013). Multivariate analysis found preoperative chronic steroid use to be an independent predictor of mortality within 30 days following aRCR (OR 8.15, confidence interval (CI) 1.45-45.86; P=.017). Chronic steroid use was not found to be an independent risk factor for infection, readmission, or reoperation following aRCR. It was, however, found to be independently associated with higher rates of 30-day mortality following aRCR, although with a limited overall number of deaths reported.

Infection rate among close contacts of patients with coronavirus disease in Japan: a descriptive study and literature review.

In Japan, on April 20, 2020, the definition of a close contact regarding coronavirus disease (COVID-19) was changed from a long-term contact time to a specified contact time of 15 min and from a contact distance of 2 m to 1 m. We aimed to determine the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rate among close contacts of patients with COVID-19 and determine the impact of the infection on transmission among close contacts. The numbers of SARS-CoV-2 tests, SARS-CoV-2-positive cases, and close contacts of patients with COVID-19 were assessed between March 2020 and February 2021 in Fukui Prefecture, Japan. The study period was subdivided into 3 periods. The second and third period contained data with the changed definition of close contact. Overall, 32,238 SARS-CoV-2 tests were performed. There were 545 patients with COVID-19 and 1487 close contacts, of whom 267 tested positive. The highest infection rate occurred in period 3. Distance, protective measures, and contact time with COVID-19 patients influenced the increased infection rate. The infection rate showed a rising trend from 11.1% in period 1 to 19.2% and 20.0% in periods 2 and 3, respectively (Cochran-Armitage test; P < 0.004). Multivariate analysis revealed that female sex was an independent risk factor for infection of close contacts (odds ratio: 2.23; 95% confidence interval: 1.700-2.930). Female sex is a risk factor for transmission by close contacts. The rate of infection among close contacts may be associated with contact time, contact distance, and protective measures.

Risk Factors for Infections of Cardiac Implantable Electronic Device in Saudi Arabia

Background and Objectives: Cardiac implantable electronic device (CIED) infections are increasing worldwide due to the increased use of implantable cardiac devices. (CIED) infection is a serious complication that is associated with increased mortality and morbidity as well as increased healthcare costs. However, risk factors for infection of implanted devices are poorly documented in Saudi Arabia. We aimed to determine risk factors for CIED infection in our region. Methods and Results: A retrospective study was carried out in cardiology departments at different centers in Saudi Arabia. Our population consisted of all patients with device-related infections over twenty years from January 2009 to December 2020 with one control case matched to each confirmed infection of the implanted device, resulting in 137 patients with device infection. The mean age was 58±16 years, where males constituted 75.2%. Most infections occurred in patients with the first implant. (63.5%) patients had chronic kidney disease, (59.9%) of patients had diabetes mellitus, (65%) of patients had hypertension, and (43.1%) of patients had coronary artery disease. Most of the patients had a pocket infection. Preop antibiotics were obtained in all patients before implanting. The median time from the last surgical intervention involving the device to infection symptoms was 730 days. The median length of hospitalization was 27±23 days. 130 patients survived at the time of discharge, resulting in an overall mortality rate of 5.1%. Using Multivariate analysis, we identified male gender (P = 0.000), hypertension HTN (P = 0.002), diabetes DM (P = 0.006), and presence of underlying heart disease CHD (P = 0.000) Type of the device (P = 0.000) as significantly associated with a higher risk of CIED infection. Conclusion: Our data show that gender, diabetes, hypertension, and heart disease are independent risk factors for infection after cardiac device implantation. As regards device characteristics, ICD device is associated with a higher infection rate compared to other devices.

Risk factors for infections after arthroscopic rotator cuff repair

To explore risk factors for infections after arthroscopic rotator cuff repair, and improve the under standing for reducing infection. Clinical data of 2 591 patients who underwent arthroscopic rotator cuff repair from January 2019 to January 2022 were retrospectively analyzed, including 1 265 males and 1 326 females, aged from 25 to 82 years old with an average age of (51.5±15.6) years old. They were divided into infection group(n=18) and uninfected group(n=2 573) according to whether or not patients had postoperative infection. Gender, age, smoking, diabetes, body mass index, local closure within 1 month before operation, operation time, preventive use of antibiotics, and internal fixation implantation between two groups were recorded. Univariate Logistic regression analysis screened factors associated with infections after arthroscopic rotator cuff repair. Theresultswere entered into the multivariate logistic regression analysis, screening the high risk factors for infections after arthroscopic rotator cuff repair. In 2 591 patients, 18 patients were infected after operation, infection rate was 0.69%. Univariate Logistic regression analysis showed that gender, age, operation time, antibiotic prophylaxis, internal fixation implantation were risk factors for infections after arthroscopic rotator cuff repair. Multivariate Logistic regression analysis showed male(OR=14.227), age≥65 years(OR=34.313), operation time≥2 h (OR=15.616), without antibiotic prophylaxis(OR=4.891), and internal fixation implantation(OR=5.103) were major risk factors for infection after arthroscopic rotator cuff repair(P<0.05). Male, age≥65 years, operation time≥2 h, without antibiotic prophylaxis and internal fixation implantation were independent risk factors for infection after arthroscopic rotator cuff repair. Early diagnosis and timely treatment should be carried out to reduce the incidence of infection.

Influencing factors and predictive model of postoperative infection in patients with primary hepatic carcinoma

BackgroundThe purpose of this study was to explore the risk factors for postoperative infection in patients with primary hepatic carcinoma (PHC), build a nomogram prediction model, and verify the model to provide a better reference for disease prevention, diagnosis and treatment.MethodsThis single-center study included 555 patients who underwent hepatobiliary surgery in the Department of Hepatobiliary Surgery of Tianjin Third Central Hospital from January 2014 to December 2021, and 32 clinical indicators were selected for statistical analysis. In this study, Lasso logistic regression was used to determine the risk factors for infection after liver cancer resection, establish a predictive model, and construct a visual nomogram. The consistency index (C-index), calibration curve, and receiver operating characteristic (ROC) curve were used for internal validation, and decision curve analysis (DCA) was used to analyze the clinical applicability of the predictive model. The bootstrap method was used for intramodel validation, and the C-index was calculated to assess the model discrimination.ResultsAmong the 555 patients, 279 patients met the inclusion criteria, of whom 48 had a postoperative infection, with an incidence rate of 17.2%. Body mass index (BMI) (P = 0.022), alpha-fetoprotein (P = 0.023), total bilirubin (P = 0.016), intraoperative blood loss (P < 0.001), and bile leakage (P < 0.001) were independent risk factors for infection after liver cancer surgery. The nomogram was constructed and verified to have good discriminative and predictive ability. DCA showed that the model had good clinical applicability. The C-index value verified internally by the bootstrap method results was 0.818.ConclusionPostoperative infection in patients undergoing hepatectomy may be related to risk factors such as BMI, preoperative AFP level, TBIL level, intraoperative blood loss and bile leakage. The prediction model of the postoperative infection nomogram established in this study can better predict and estimate the risk of postoperative infection in patients undergoing hepatectomy.

Investigation of comorbidities in dogs with leishmaniosis due to Leishmania infantum

In endemic areas, dogs with leishmaniosis due to Leishmania infantum frequently have comorbidities, including mostly neoplastic, infectious, and parasitic diseases. The aim of this study was to compare the prevalence of comorbidities among dogs that are not infected by L. infantum, dogs that are infected but do not present leishmaniosis, and dogs with leishmaniosis, and to examine if certain comorbidities are independent risk factors for the infection by L. infantum and/or for the development of canine leishmaniosis (CanL). A total of 111 dogs, older than 1-year and non-vaccinated against CanL, were allocated into three groups: group A (n=18) included dogs that were not infected by L. infantum, group B (n=52) included dogs that were infected by L. infantum but did not present CanL, and group C (n=41) included dogs with CanL. Signalment and historical data were obtained using a structured questionnaire. Laboratory examinations included complete blood count, serum biochemistry, urinalysis, fecal parasitology, modified Knott's test, microscopic examination of capillary blood, buffy coat, lymph node, bone marrow and conjunctival smears, qualitative serology for Dirofilaria immitis, Anaplasma phagocytophilum/A. platys, Borrelia burgdorferi and E. canis, IFAT for L. infantum, ELISA for Babesia spp. and Neospora caninum, and real-time PCR for L. infantum in bone marrow, skin biopsies and conjunctival swabs. A variety of comorbidities were found in all three groups. No independent risk factors for infection by L. infantum were found. On the contrary, among dogs infected by L. infantum, being a mongrel [odds ratio (OR): 11.2], not receiving prevention for dirofilariosis (OR: 26.5) and being seropositive to N. caninum (OR: 17.1) or to Babesia spp. (OR: 37.6), were independent risk factors for presenting CanL. Although no comorbidities influence the probability of canine infection by L. infantum, certain comorbidities may be precipitating factors for the transition from the subclinical infection by L. infantum to the overt CanL.

Clinical Characteristics and Nomogram Model of Nosocomial Infection in Patients with Newly Diagnosed Multiple Myeloma

To explore the clinical characteristics of nosocomial infection in newly diagnosed multiple myeloma(NDMM) patients, and establish a predictive nomogram model. The clinical data of 164 patients with MM who were treated in Shanxi Bethune Hospital from January 2017 to December 2021 were retrospectively analyzed. The clinical characteristics of infection were analyzed. Infections were grouped as microbiologically defined infections and clinically defined infections. Univariate and multivariate regression models were used to analyze the risk factors of infection. A nomogram was established. 164 patients with NDMM were included in this study, and 122 patients (74.4%) were infected. The incidence of clinically defined infection was the highest (89 cases, 73.0%), followed by microbial infection (33 cases, 27.0%). Among 122 cases of infection, 89 cases (73.0%) had CTCAE grade 3 or above. The most common site of infection was lower respiratory in 52 cases (39.4%), upper respiratory tract in 45 cases (34.1%), and urinary system in 13 cases (9.8%). Bacteria(73.1%) were the main pathogens of infection. Univariate analysis showed that ECOG ≥2, ISS stage Ⅲ, C-reactive protein ≥10 mg/L, serum Creatinine ≥177 μmol/L had higher correlation with nosocomial infection in patients with NDMM. Multivariate regression analysis showed that C-reactive protein ≥10 mg/L (P＜0.001), ECOG ≥2 (P=0.011) and ISS stage Ⅲ （P=0.024） were independent risk factors for infection in patients with NDMM. The nomogram model established based on this has good accuracy and discrimination. The C-index of the nomogram was 0.779（95%CI: 0.682-0.875）. Median follow-up time was 17.5 months, the median OS of the two groups was not reached (P=0.285). Patients with NDMM are prone to bacterial infection during hospitalization. C-reactive protein ≥10 mg/L, ECOG ≥2 and ISS stage Ⅲ are the risk factors of nosocomial infection in NDMM patients. The nomogram prediction model established based on this has great prediction value.

Risk Factors of Infection in Nephrotic Syndrome

Objective: To determine the risk factors of infection in patients with nephrotic syndrome. Methods: A retrospective study was conducted on 155 patients with nephrotic syndrome under our department from January 2019 to December 2019. Among them, 43 cases had infection, and the rate of infection was 27.74%. The risk factors of infection were analyzed. Results: Among the 155 patients with nephrotic syndrome, 43 cases developed infection, including 3 cases of upper respiratory tract infection (6.98%), 33 cases of lower respiratory tract infection (76.74%), 3 cases of skin infection (6.97%), 3 cases of urinary tract infection (6.97%), and 1 case of facial nerve infection (2.32%). Compared with the group without infection, the group with infection had lower serum albumin and immunoglobulin G (IgG) levels as well as higher serum creatinine and 24-hour urinary protein levels (P &lt; 0.05). Multivariate logistic regression analysis showed that decreased serum albumin (odds ratio [OR] = 1.14; P &lt; 0.01) and IgG (OR = 1.1; P &lt; 0.144) were independent risk factors for infection. Conclusion: Respiratory infection is the most common infection in nephrotic syndrome, and the decrease in serum albumin and IgG are independent risk factors for infection.

The Effect of Preoperative 25-Hydroxy Vitamin D Supplement and Surgical Site Infection

Surgical site infection (SSI) is one of the most important complications of surgery and is known in quality improvement programs as a very important indicator for evaluating the performance of surgeons and hospitals. In recent studies, interesting effects for vitamin D such as antimicrobial effects, wound healing, immune regulation, etc. have been considered and the effectiveness of this vitamin on the above has been proven in laboratory environments and animal models. Therefore, the present study was designed and performed to evaluate the effect of vitamin D tablets before surgery on surgical site infection in patients referred to Shariati Hospital. This study was performed as a randomized controlled trial (RCT) on 200 patients who underwent surgery in Shariati Hospital in Tehran and in the general surgery department between 1397 and 1398. Patients were randomly assigned to two groups of 100 persons, including intervention and control. In all patients, vitamin D levels were measured and recorded 15 days before surgery. The intervention group included patients who received 2 tablets of fifty thousand units of vitamin D seven to ten days before the operation. The second group also included patients who did not undergo any intervention and only in order to maintain blindness of the same size and simultaneously with the first group. They received a placebo. Finally, all patients were followed at intervals of one, three, seven and thirty days after surgery and then compared to the extent of infection at the site of surgery and other desired variables. In this study, 200 persons with a mean age of 47.78 years were examined. 57.5% (115 persons) were female and the rest were male. Overall, 19 (9.5%) of the patients studied underwent surgery at the site of follow-up within one month of follow-up (14 in the control group and 5 in the intervention group). Detection between the two groups was observed in terms of infection (P=0.030). In general, based on the results of the analysis, in the present study, there was a statistically significant relationship between surgical site infection with low serum vitamin D level, increase in the number of hospital days, female gender, wound classification, ASA class of patients and vitamin D consumption before surgery. (P&lt;0.05). The results of this study showed that there is a significant relationship between surgical site infection and consumption of edible vitamin D as well as serum vitamin D levels before surgery so that vitamin D deficiency can be considered as an independent risk factor for infection. Hospitals were considered, including surgical site infections. Therefore, performing preoperative tests as well as performing the required interventions can be very effective in improving this index and reducing surgical site infections.

Single-dose fosfomycin could prevent infectious complications after retrograde intrarenal surgery: A prospective study.

In this study, we aimed to show the protective effect of a single-dose Fosfomycin from infective complications against the standard usage of cephalosporine before retrograde intrarenal surgery. A total of 186 patients who underwent retrograde intrarenal surgery between 2020 and 2021, included the study. Patients were divided into two groups: group 1(n=49), patients who received an oral dose of 3g Fosfomycin tromethamine powder administered 4-6h before the operation; and group 2 (n=137): patients who received Cephalosporin 30min before surgery and an additional dose 6h after surgery. The median age and stone size were significantly higher in the cephalosporin group (P=0.006 and P=0.008, respectively). There was no statistically significant difference between the groups in terms of postoperative fever and postoperative UTI (P=0.408 and P=0.438). Additionally, no patient developed sepsis. and no adverse event was seen in either group. Preoperative urinary tract infection (UTI) and previous Extracorporeal Shock Wave lithotripsy (ESWL) were independent risk factors and increased postoperative infectious complications (O.R. 2.929 95% C.I. 0.723, P<0.001, and O.R. 2.860 95% C.I. 0.985, P=0.004, respectively). Infectious is still one of the important complications after RIRS, and preoperative UTI is an independent risk factors for infections. Fosfomycin monotherapy could be sufficient and is also effective in patients with preoperative culture positive.

Complications after Posterior Lumbar Fusion for Degenerative Disc Disease: Sarcopenia and Osteopenia as Independent Risk Factors for Infection and Proximal Junctional Disease

Proximal Junctional Disease (PJD) and Surgical Site Infection (SSI) are among the most common complications following spine surgery. Their risk factors are not fully understood. Among them, sarcopenia and osteopenia have recently been attracting interest. The aim of this study is to evaluate their influence on mechanical or infective complications after lumbar spine fusion. Patients who underwent open posterior lumbar fusion were analyzed. Through preoperative MRI, central sarcopenia and osteopenia were measured with the Psoas Lumbar Vertebral Index (PLVI) and the M-Score, respectively. Patients were stratified by low vs. high PLVI and M-Score and then by postoperative complications. Multivariate analysis for independent risk factors was performed. A total of 392 patients (mean age 62.6 years, mean follow up 42.4 months) were included. Multivariate linear regression identified comorbidity Index (p = 0.006), and dural tear (p = 0.016) as independent risk factors for SSI, and age (p = 0.014) and diabetes (p = 0.43) for PJD. Low M-score and PLVI were not correlated to a higher complications rate. Age, comorbidity index, diabetes, dural tear and length of stay are independent risk factors for infection and/or proximal junctional disease in patients who undergo lumbar arthrodesis for degenerative disc disease, while central sarcopenia and osteopenia (as measured by PLVI and M-score) are not.