Independent Risk Factors For Infection Research Articles

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 < 0.05). Multivariate logistic regression analysis showed that decreased serum albumin (odds ratio [OR] = 1.14; P < 0.01) and IgG (OR = 1.1; P < 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<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.

Factors Affecting Incidence of Ventilator-Associated Pneumonia With Multidrug-Resistant Microbes in Intensive Care Unit

Ventilator-associated pneumonia (VAP) with multidrug-resistant (MDR) microbes is one of the leading causes of hospital mortality. In this study, the risk factors of pneumonia with MDR microbes are investigated. This work was a retrospective study conducted at 2 academic centers and 3 intensive care units (ICUs). All patients who were clinically suspected VAP and had a positive microbial culture have been included in this study from late March 2018 to mid-June 2019. Patients were divided into 2 groups: MDR and non-MDR. Clinical and paraclinical (CBC, microbial culture, CXR) findings of these patients were recorded and reviewed. Then, using the multivariate analysis, the factors affecting the incidence of VAP with MDR microbes were investigated. Out of the 1854 patients admitted to the ICU, 110 of them have been diagnosed with VAP using X-ray and microbiological findings, and MDR microbes were separated in the culture of 85 patients. The mean age range of the patients was 60 ± 20 years and 75% of them were male. In univariate analysis, the factors affecting the incidence of MDR VAP were as follows: length of stay in the ICU, length of stay in other wards, history of admission in ward before ICU, duration of mechanical ventilation, and diabetes. In multivariate analysis, diabetes (odds ratio, 2.66; 95% confidence interval, 0.9–7.8; P = 0.002), history of admission in ward before ICU (odds ratio, 10.25; 95% confidence interval, 3.17–33.1), and a combination of the 3 factors related to the length of exposuring health care environment which named FAC, were independent risk factors of infection with MDR microbes. Hence, the FAC variable includes the length of stay in ICU, duration of mechanical ventilation, and length of stay in other wards.

Osteopenia and Sarcopenia as Potential Risk Factors for Surgical Site Infection after Posterior Lumbar Fusion: A Retrospective Study.

Surgical site infection (SSI) is a feared complication in spinal surgery, that leads to lower outcomes and increased healthcare costs. Among its risk factors, sarcopenia and osteopenia have recently attracted particular interest. The purpose of this article is to evaluate the influence of sarcopenia and osteopenia on the postoperative infection rate in patients treated with posterior fusion for degenerative diseases of the lumbar spine. This retrospective study included data from 308 patients. Charts were reviewed and central sarcopenia and osteopenia were evaluated through magnetic resonance images (MRI), measuring the psoas to lumbar vertebral index (PLVI) and the M score. Multivariate linear regression was performed to identify independent risk factors for infection. The postoperative SSI rate was 8.4%. Patients with low PLVI scores were not more likely to experience postoperative SSI (p = 0.68), while low M-score patients were at higher risk of developing SSI (p = 0.04). However, they did not generally show low PLVI values (p = 0.5) and were homogeneously distributed between low and high PLVI (p = 0.6). Multivariate analysis confirmed a low M score to be an independent risk factor for SSI (p = 0.01). Our results suggest that osteopenia could have significant impact on spinal surgery, and prospective studies are needed to better investigate its role.

Carbapenems versus Cephalosporin or Piperacillin-Tazobactam as Perioperative Antibiotic Prophylaxis in Liver Transplant Recipients with Model for End-Stage Liver Disease Scores of ≥30: A Retrospective Study in a Chinese Population.

ObjectivePerioperative prophylaxis, commonly with a third-generation cephalosporin plus ampicillin or piperacillin-tazobactam, is usually employed to prevent infections in liver transplantation (LT) recipients. Patients with a high Model for End-Stage Liver Disease (MELD) score have an increased infection risk after LT. However, whether carbapenems could be used as surgical prophylaxis in these high-risk patients remains unclear. Therefore, this study aimed at comparing the effectiveness of carbapenems with that of cephalosporin or piperacillin-tazobactam for surgical prophylaxis in high-risk LT recipients with a MELD score ≥30.Design or MethodsThis retrospective study included adult patients with a MELD score ≥30 who underwent LT between May 2018 and September 2020. We comparatively analyzed the infection rate and outcome between patients using cefoperazone-sulbactam or piperacillin-tazobactam and those using carbapenems as surgical prophylaxis.ResultsThis study included 105 LT recipients. Seventy-eight and 27 patients used non-carbapenem and carbapenem antibiotics, respectively, as surgical prophylaxis. The corresponding infection incidence rates within 30 days were 38.5% and 66.7% (p = 0.011). Multivariate analysis revealed that reoperation and the Child–Pugh score were independent risk factors for infections within 30 days after LT. The following four risk factors were associated with the 180-day post-LT survival: MELD score, vascular complication, intra-abdominal bleeding, and infection with carbapenem-resistant organisms (CROs). There was no significant difference in CRO infection incidence between the carbapenem and non-carbapenem groups (18.5% vs 11.5%; p = 0.345).ConclusionCarbapenem use as surgical prophylaxis was not associated with infection incidence within 30 days after LT, 180-day post-LT survival or CRO infection. Therefore, carbapenems are not superior to cephalosporin or piperacillin-tazobactam for perioperative antibiotic prophylaxis in LT recipients with a MELD score ≥30.

A case-control study of infections caused by Klebsiella pneumoniae producing New Delhi metallo-beta-lactamase-1: Predictors and outcomes.

IntroductionInfections caused by antimicrobial-resistant bacteria are a significant cause of death worldwide, and carbapenemase-producing bacteria are the principal agents. New Delhi metallo-beta-lactamase-1 producing Klebsiella pneumoniae (KP-NDM-1) is an extensively drug-resistant bacterium that has been previously reported in Mexico. Our aim was to conduct a case–control study to describe the risk factors associated with nosocomial infections caused by K. pneumoniae producing NDM-1 in a tertiary-care hospital in Mexico.MethodsA retrospective case–control study with patients hospitalized from January 2012 to February 2018 at the Hospital Civil de Guadalajara “Fray Antonio Alcalde” was designed. During this period, 139 patients with a culture that was positive for K. pneumoniae NDM-1 (cases) and 486 patients hospitalized in the same department and on the same date as the cases (controls) were included. Data were analyzed using SPSS v. 24, and logistic regression analysis was conducted to calculate the risk factors for KP-NDM-1 infection.ResultsOne hundred and thirty-nine case patients with a KP-NDM-1 isolate and 486 control patients were analyzed. In the case group, acute renal failure was a significant comorbidity, hospitalization days were extended, and significantly more deaths occurred. In a multivariate analysis of risk factors, the independent variables included the previous use of antibiotics (odds ratio, OR = 12.252), the use of a urinary catheter (OR = 5.985), the use of a central venous catheter (OR = 5.518), the use of mechanical ventilation (OR = 3.459), and the length of intensive care unit (ICU) stay (OR = 2.334) as predictors of infection with NDM-1 K. pneumoniae. ConclusionIn this study, the previous use of antibiotics, the use of a urinary catheter, the use of a central venous catheter, the use of mechanical ventilation, and ICU stay were shown to be predictors of infection with NDM-1 K. pneumoniae and were independent risk factors for infection with NDM-1 K. pneumoniae.

A real-world study of infectious complications of venetoclax combined with decitabine or azacitidine in adult acute myeloid leukemia.

The purpose of this study was to identify the incidence, sites and main pathogens, and risk factors for infectious complications occurring in patients with adult acute myeloid leukemia (AML) during the first course of venetoclax combined with decitabine or azacitidine. A retrospective cohort analysis was performed of 81 patients with AML older than 14years who received the first cycle of venetoclax combined with a hypomethylating agent (HMA) between March 2018 and March 2021 at our institution. Infectious complications, if any, were documented. Among a total of 81 cases of AML, 59 (72.8%) patients occurred infections, including fever without an identifiable source (28.8%), clinically documented infections (40.7%), and microbiologically documented infections (30.5%). The most commonly isolated organism in culture was Candida albicans, followed by Klebsiella pneumonia, and Pseudomonas aeruginosa. The 4-week and 8-week mortality rates were 3.7% and 7.4%, respectively. In multivariate analysis, a high proportion of blasts in bone marrow, decreased hemoglobin level, and fever with or without a documented infection at baseline were significant independent risk factors for infectious complications. Compared with conventional chemotherapy, the incidence of infectious complications of venetoclax combined with decitabine or azacitidine significantly decreased. Pretreatment high leukemia burden and fever were independent risk factors for infections.

High Prevalence of Both Previous Infection with SARS-CoV-2 and Persistent Symptoms.

Universities are unique settings with large populations, congregate housing, and frequent attendance of events in large groups. However, the current prevalence of previous COVID-19 infection in university students, including symptomatic and asymptomatic disease, is unknown. Our goal therefore was to determine the prevalence of previous infection, risk factors for infection, and the prevalence of persistent symptoms following infection among university students. This was a cross-sectional study set in a large public university between January 22 and March 22, 2021. We surveyed students about demographics, risk factors, and symptoms, and simultaneously tested their saliva for IgA antibodies to SARS-CoV-2. To estimate the prevalence of previous infection we adjusted our intentional sample of a diverse student population for year in school and age to resemble the composition of the entire student body and adjusted for the imperfect sensitivity and specificity of the antibody test. Univariate and multiple regression analysis was used to identify independent risk factors for infection, and the proportion of students with persistent symptoms following acute infection was determined. A total of 488 students completed the survey, 432 had a valid antibody result, and 428 had both. The estimated prevalence of previous infection for 432 participants with valid antibody results was 41%. Of 145 students in our sample with a positive antibody test, 41.4% denied having a previous positive polymerase chain reaction (PCR) test for SARS-CoV-2 and presumably had an asymptomatic infection; in our adjusted analysis we estimate that approximately 2-thirds of students had asymptomatic infections. Independent risk factors for infection included male sex, having a roommate with a known symptomatic infection, and having two or fewer roommates. More frequent attendance of parties and bars was a univariate risk factor, but not in the multiple regression analysis. Of 122 students reporting a previous symptomatic infection, 14 (11.4%) reported persistent symptoms consistent with postacute COVID-19 a median of 132 days later. Previous COVID-19 infection, both symptomatic and asymptomatic, was common at a large university. Measures that could prevent resurgence of the infection when students return to campus include mandatory vaccination policies, mass surveillance testing, and testing of sewage for antigen to SARS-CoV-2.

Antibiotic Prophylaxis for Upper Gastrointestinal Bleed in Liver Cirrhosis; Less May Be More.

Administration of antibiotics in patients with cirrhosis and upper gastrointestinal bleeding has been shown to improve outcomes. Little is known regarding optimum duration of prophylactic antibiotics. Seven days of antibiotics are generally recommended but very few studies have compared antibiotic duration to clinical outcomes in current available scientific literature. The goal of our study was to study the effect of shorter antibiotic duration on patient outcomes. We conducted a retrospective cohort study of patients with cirrhosis presenting with upper GI bleeding at our institute from 2010 to 2018. Patients were divided into three cohorts based on duration of antibiotic administration for prophylaxis: 1-3days of antibiotics, 4-6days of antibiotics and 7days or more of antibiotics. Rates of infection diagnosis within 30days, rebleeding, and mortality were compared between the three groups with Chi square, Fisher Exact and Kruskall-Wallace tests. Multivariable analysis was conducted to evaluate independent risk factors for infection. Medical charts of 980 patients with cirrhosis and upper GI bleeding during the study period were reviewed. A total of 303 with upper gastrointestinal bleeding were included in the final sample, of these 243 patients received antibiotics for prophylaxis and were included for analysis. Seventy-seven patients received antibiotic therapy for 3days or less, 69 patients for 4-6days, and 97 patients longer than 6days. The three groups were well matched in demographic and clinical variables. Twenty-seven patients developed infections within 30days of bleeding. MELD-Na score at presentation and presence of ascites were associated with infection within 30days. Rates of infection were not statistically different between the three antibiotic groups (p = 0.78). In the thirty days following the GI bleed, pneumonia was the most diagnosed infection (eleven patients) followed by urinary tract infections (eight patients). Four patients developed spontaneous bacterial peritonitis and three were diagnosed with bacteremia. There was no difference in time to infection (Kruskall Wallace test p = 0.75), early re-bleeding (p = 0.81), late re-bleeding (p = 0.37) and in-hospital mortality (p = 0.94) in the three groups. Six patients in the cohort developed C. Difficile infection; no patient in the short antibiotic group developed C. Difficile infection. Short course of antibiotics for prophylaxis (3days) appears safe and adequate for prophylaxis in patients with cirrhosis with upper gastrointestinal bleeding if there is no active infection.

Risk factors of infection of totally implantable venous access port: A retrospective study.

Infection is the most frequent complication associated with the use of totally implantable venous access port (TIVAP). This retrospective study was conducted to determine the risk factors affecting TIVAP-related infection. A total of 1406 patients implanted with TIVAP at our center were included in this retrospective study. Incidence of perioperative infection, patient characteristics and bacteriologic data were retrieved and analyzed. Univariable analyses and multiple logistic regression analyses were used to determine the risk factors. Overall, 72 (5.1%) patients had perioperative infection, and TIVAP was finally removed from 12 (0.85%) patients. There was significantly more hematologic malignancy in the infection group, compared to the non-infection group. Patients with chemotherapy and infection within 30 days before operation also had more infections. There were more inpatients in the infection group than in the non-infection group. The rate of hematoma was higher in the infected patients. Multivariate logistic analysis revealed that hematoma (OR 5.695, p < 0.001), preoperative hospital stay (⩾14d) (OR 2.945, p < 0.001), history of chemotherapy (OR 2.628, p = 0.002), history of infection (within 30 days) (OR 4.325, p < 0.001) were independent risk factor for infection. This study demonstrated that hematoma, preoperative hospital stay (⩾14d), history of chemotherapy and history of infection (within 30 days) are independent risk factor for all patients.

The effect of preoperative urine culture and bacterial species on infection after percutaneous nephrolithotomy for patients with upper urinary tract stones

To study the relationship between preoperative urine culture, bacterial species and infection after percutaneous nephrolithotomy in patients with upper urinary tract stones, and summarize the clinical characteristics of different bacterial infections. From January 2014 and January 2020, 963 patients with upper urinary tract stones who underwent PCNL in the department of urology of Fujian provincial hospital were included in the study. Information included the patient’s age, gender, weight, diabetes, chronic disease history, urine routine, preoperative urine culture results, stone size, number of stones, hydronephrosis level, operation time, body temperature, heart rate, blood pressure, breathing rate, hemoglobin, serum creatinine, bilirubin, platelets and whether there was preoperative infection were recorded. 141 patients (14.6%) had a positive urine culture before surgery, and 7 of them had multiple bacterial infections. The most common pathogenic bacteria was Escherichia coli, followed by Enterococcus and Klebsiella pneumoniae. A total of 74 cases (7.7%) of 963 patients with infection after PCNL occurred, 24 cases (32.4%) of infected patients progressed to urinary septic shock. Univariate analysis shown that the probability of infection in patients with long operation time and positive urine culture was significantly higher, and the difference was statistically significant. Further multivariate logistic regression analysis shown that positive urine culture before operation and long operation time were independent risk factors for infection after PCNL. Among the 29 patients with septic shock, 18 cases (62.1%) had a positive urine culture before surgery. The incidence (43.9%) of postoperative infection in Escherichia coli positive patients was significantly higher than that in the negative group, and the difference was statistically significant. The rate of patients with Escherichia coli infection progressing to septic shock was 9 cases (60%). 2 patients with Enterococcus faecium infection and 2 patients with Klebsiella pneumoniae infection all progressed to septic shock. The age of patients with post-PCNL infection caused by Escherichia Coli, Enterococcus faecium and Klebsiella pneumoniae were 58.53 ± 11.73 years, 76.5 years and 74 years.The body temperature of patients with post-PCNL infection caused by Escherichia Coli, Enterococcus faecium and Klebsiella pneumoniae were 39.10 ± 0.25 °C, 39.45 °C and 38.65 °C. The highest pct value of patients with post-PCNL infection caused by Escherichia Coli, Enterococcus faecium and Klebsiella pneumoniae were 80.62 ± 31.45 ng/mL, 24.32 ng/mL and 8.45 ng/mL. The nitrite positive rate of patients with post-PCNL infection caused by Escherichia Coli, Enterococcus faecium and Klebsiella pneumoniae were 64.51%, 16.6% and 0. Postoperative infection of PCNL is significantly correlated with positive preoperative urine culture, and positive preoperative urine culture is an independent risk factor for postoperative infection. The most common pathogen of postoperative infection of PCNL is Escherichia coli, followed by Enterococcus and Klebsiella pneumoniae. Patients with Escherichia coli infection are often positive for nitrite before surgery, mainly manifested by high fever, and PCT is significantly increased (often exceeded 100 ng/ml). Enterococcus faecium and Klebsiella pneumoniae infections mostly occur in elderly patients and often progress to septic shock. Patients with Enterococcus faecium infection have a high fever, and the PCT value is significantly higher (often exceeded 20 ng/ml). Patients with Klebsiella pneumoniae infection have a moderate fever, and the PCT value generally does not exceeded 10 ng/ml. Long operation time is another independent risk factor for PCNL infection.

Immunoglobulin substitution in patients with secondary antibody deficiency in chronic lymphocytic leukemia and multiple myeloma: a representative analysis of guideline adherence and infections

IntroductionIn secondary immunodeficiency, immunoglobulin replacement therapy (IgRT) is recommended by guidelines (GL) for patients with IgG level < 4 g/l and more than 3 infections or a severe infection. IgRT may be appropriate if IgG level < 4 g/l and/or 1–3 less severe infections (≤ grade 2).MethodsThis was a retrospective sample analysis representative for practices and hospitals in Germany. The treatments and infection data were collected from patients with chronic lymphocytic leukemia (CLL) and multiple myeloma (MM). GL adherence (GLAD) was analyzed.ResultsData from 1086 patients (CLL 490, MM 596) were collected from 86 centers. Of all patients, 34.8% developed IgG deficiency during therapy (CLL 35.5%; MM 34.2%). IgRT was given in 23.5% of CLL and 14.4% of MM patients. GLAD in hypogammaglobulinemia and indication to IgRT was 23.3% of 86 CLL and 22.1% of 77 MM patients. Without GLAD, the hazard ratio (HR) for any infection was 4.49 (95% CI 3.72–5.42; p < 0.001) and for severe infections (grade ≥ 3) 10.64 (95% CI 7.54–15.00; p < 0.001). Significant independent risk factors for infections were a higher Charlson Comorbidity Index, IgG deficiency, and 3rd + line treatment, as well as therapy with BTK inhibitors or chemotherapy in CLL. Multivariable analysis showed a significantly lower risk of severe infections after start of IgRT with a HR of 0.47 (95% CI 0.28–0.77; p = 0.003).ConclusionsGuideline adherence correlated with fewer and less severe infections but was low in patients with indication to IgRT. Risk factors for infection can be identified. Risk of severe infections was significantly lower in patients with IgRT.

Risk factors for SARS-CoV-2 infection and hospitalisation in children and adolescents in Norway: a nationwide population-based study

ObjectiveTo determine risk factors for SARS-CoV-2 infection and hospitalisation among children and adolescents.DesignNationwide, population-based cohort study.SettingNorway from 1 March 2020 to 30 November 2021.ParticipantsAll Norwegian residents<18 years of age.Main outcome...

Infection is not rare in patients with idiopathic inflammatory myopathies.

To assess the prevalence and characteristics of infections in patients with idiopathic inflammatory myopathies (IIM) and analyse risk factors for infection using clinical presentation and biochemical findings of IIM. Retrospective review of the medical records of patients with IIM followed up in a single medical centre from January 2008 to January 2018. Of the 779 patients with IIM, 215 (27.6%) suffered from infections. The prevalence of infection in dermatomyositis (DM) (29.8%) was more than polymyositis (PM) (18.5%). The lung was the most common infection site (66.5%). Multivariate analyses demonstrated that methylprednisolone pulse (MP) (OR=3.22; 95% CI=1.60 - 6.48; p=0.001), age of onset >50 years (OR=1.02; 95% CI=1.00 - 1.03; p=0.011), anti-melanoma differentiation-associated gene 5 (MDA5) antibody (OR=1.93; 95% CI=1.20 - 3.11; p=0.007), lymphocyte count <1200/mm3 (OR=2.85; 95% CI=1.89 - 4.30; p<0.001), and interstitial lung diseases (ILD) (OR=2.03; 95% CI=1.30 - 3.71; p=0.002) are independent risk factors for infection. Survival analysis demonstrated that the three-year survival rate in the infection group was lower than the no-infection group (75.3% vs. 94.7%, p < 0.001). Among hospitalised individuals with IIM, infection is frequent and the leading cause of mortality. The anti-MDA5 antibody, lymphopenia, ILD, old age, and treatment with MP are contributing factors in the development of infections in patients with IIM.

Is pin-plate overlap in tibial plateau fractures associated with increased infection rates?

IntroductionDespite advances in the treatment of high energy proximal tibia fractures, including the utilization of staged management with external fixation, the infection rate remains high. Overlap between external fixator pin sites and definitive internal fixation has been proposed as a risk factor for infection. MethodsThis retrospective study reviews 244 patients with staged knee-spanning external fixation followed by delayed definitive internal fixation at two separate level one trauma centers. Presence of pin-plate overlap as well as several other known risk factors for infection were recorded and measured to include open fractures, compartment syndrome, operative time and number of incisions. Development of deep infection was the primary outcome. Both univariate and multivariate statistics were applied to determine differences in rates of infection. Results65 (26.6%) patients had presence of pin-plate overlap while 179 (73.4%) patients had no overlap. There were no differences between overlapping and non-overlapping groups with respect to other infectious risk factors. Deep infection occurred in 34 (13.9%) total patients, 18 (27.7%) were in patients with pin-plate overlap and 16 (8.9%) in those without overlap. (P = 0.003; RR 3.01, 95% CI 1.51–4.76). DiscussionThis large, multicenter study demonstrated a statistically significant association between pin-plate overlap and the development of deep infection in tibial plateau fractures. On multivariate analysis, pin-plate overlap was identified as an independent risk factor for infection. When treating these complex injuries, surgeons should consider the definitive fixation construct when placing external fixation pins.

Safety and Efficacy of Nonoperative Treatment in Esophageal Perforation Caused by Foreign Bodies.

INTRODUCTION:Esophageal foreign bodies are often treated by endoscopy, but the treatment of esophageal perforation caused by foreign bodies remains controversial. The purpose of this study was to investigate the safety and efficacy of nonoperative treatment of esophageal perforation caused by foreign bodies.METHODS:We retrospectively analyzed 270 patients admitted to our hospital for esophageal perforation caused by foreign bodies from January 2012 to December 2020, all of whom received nonoperative treatment.RESULTS:The mean age of the patients was 56 ± 17 years, and fish bones were the most common type of foreign body. A total of 61.2% of the perforations were in the cervical esophagus. All patients received nonoperative treatment initially, and the foreign body removal rate using endoscopy reached 97%. The perforation healing rate reached 94.8%, whereas 3 patients (1.1%) died during hospitalization. The median (range) duration of hospitalization was 4 days (3–6). Multivariable analysis showed age ≥ 66 years (odds ratio [OR]: 2.196; 95% confidence interval [CI]: 1.232–3.916; P = 0.008), men (OR: 1.934; 95% CI: 1.152–3.246; P = 0.013), and time to treatment (OR: 1.126; 95% CI: 1.027–1.233; P = 0.011) were independent risk factors for infection, whereas the risk of infection was lower when the foreign body type was fish bone (OR: 0.557; 95% CI: 0.330–0.940; P = 0.028).DISCUSSION:Nonoperative treatment is safe and effective for esophageal perforation caused by foreign bodies. Even if perforation is combined with infection, active nonoperative treatment can still achieve a good effect. Early intervention can effectively reduce the risk of infection and improve patient outcomes.