Low Likelihood Of Infection Research Articles

Comparison of diagnostic spectrum between inflammation of unknown origin and fever of unknown origin: A systematic review and meta-analysis

BackgroundPatients with inflammation of unknown origin (IUO) and fever of unknown origin (FUO) are commonly considered a single population. Differences in underlying causes between both groups may steer the diagnostic work-up. MethodsPubMed, Embase, Web of Science, and ClinicalTrials.gov were searched from July 2009 through December 2023. Studies including both FUO and IUO patients with a sample size of ≥20 were considered. The primary outcome was the difference in the rate of patients affected by predefined diagnostic categories according to meeting FUO or IUO criteria. Data were pooled using random-effects models. ResultsA total of 8 studies met criteria for inclusion, with a total of 1452 patients (466 with IUO and 986 with FUO). The median rate of IUO patients among the included studies was 32 % (range 25–39 %). Patients with IUO had a lower likelihood of infection (OR 0.59 [95 % CI; 0.36–0.95]; I2 0 %). There were no significant differences in the rate of noninfectious inflammatory disorders, malignancies, miscellaneous disorders, or remaining undiagnosed. Comparison of diagnostic subgroups revealed that IUO patients were less likely to have systemic autoinflammatory disorders (OR 0.17 [95 % CI, 0.05–0.58]; I2 42 %) and more likely to have vasculitis (OR 2.04 [95 % CI, 1.23–3.38]; I2 21 %) and rheumatoid arthritis or spondylarthritis (OR 3.52 [95 % CI, 1.16–10.69]; I2 0 %). ConclusionBased on our findings, there is little reason to assume that FUO and IUO patients would benefit from a different initial diagnostic approach.

Outcomes of Incisional Surgical Site Infection without Mesh to Prevent Incisional Hernia

Background: wound infections that develop after a hernia repair can be linked to systemic issues, mesh infections, and hernia recurrence. Objective: To assess outcomes of incisional surgical site infection without mesh to prevent incisional hernia. Methodology: This was a Prospective interventional study which was conducted in Department of Colorectal Surgery Bangabandhu Sheikh Mujib Medical University fromApril, 2019- September, 2020 using a semi-structured questionnaire through face to face interview. Data were analysed using a computer programme SPSS 24.0 version. Result: the mean age of the respondents was 56.73±7.72 years. About 80% were male. The mean BMI was 25±5.5. About 16.7% had Parastomal Hernia and 8.3% had midline Incisional Hernia. 3 patients at 4th week and 1 patient at 3rd month had surgical site infection. Conclusion: Hernia operations are traditionally regarded as clean operations due to the anticipated, low likelihood of infection at the site of surgical intervention (SSI).

Factors associated with COVID-19 Infection among a national population of individuals with schizophrenia or schizoaffective disorder in the United States

BackgroundIndividuals with schizophrenia are a vulnerable and under-served population who are also at risk for severe morbidity and mortality following COVID-19 infection. Our research was designed to identify factors that put individuals with schizophrenia at increased risk of COVID-19 infection.MethodsThis study was a retrospective cohort analysis of medical and pharmacy claims among 493,796 individuals residing in the United States with schizophrenia or schizoaffective disorder, between January 1, 2019 and June 30, 2020. A confirmed diagnosis of COVID-19 infection by September 30, 2020 was regressed on demographics, social determinants, comorbidity, and pre-pandemic (December 2019 – February 2020) healthcare utilization characteristics.ResultsA total of 35,249 (7.1%) individuals were diagnosed with COVID-19. Elevated odds of COVID-19 infection were associated with age, increasing consistently from 40-49 years (OR: 1.16) to 80+ years (OR:5.92), male sex (OR: 1.08), Medicaid (OR: 2.17) or Medicare (OR: 1.23) insurance, African American race (OR: 1.42), Hispanic ethnicity (OR: 1.23), and higher Charlson Comorbidity Index. Select psychiatric comorbidities (depressive disorder, adjustment disorder, bipolar disorder, anxiety, and sleep-wake disorder) were associated with elevated odds of infection, while alcohol use disorder and PTSD were associated with lower odds. A pre-pandemic psychiatry (OR:0.56) or community mental health center (OR:0.55) visit were associated with lower odds as was antipsychotic treatment with long-acting injectable antipsychotic (OR: 0.72) and oral antipsychotic (OR: 0.62).ConclusionsAmong individuals with schizophrenia, risk of COVID-19 infection was substantially higher among those with fewer economic resources, with greater medical and psychiatric comorbidity burden, and those who resided in African American or Hispanic communities. In contrast, individuals actively engaged in psychiatric treatment had substantially lower likelihood of infection. These results provide insights for healthcare providers that can translate into improved identification of at-risk individuals and interventions to reduce the risk and consequences of COVID-19 infection.

Updates in Sepsis Management Show Thoughtful Approach

Updates in Sepsis Management Show Thoughtful Approach

Piloting a randomized, double-blind, placebo-controlled study design at a community hospital to evaluate prophylactic antibiotics in endoscopic carpal tunnel release: Clinical, logistic, and economic considerations

Surgical site infection is low following endoscopic carpal tunnel release (ECTR), yet antibiotic prophylaxis is still common in these procedures. This study piloted a randomized, double-blind, placebo-controlled study design at a community hospital to generate discourse in support of discontinuing antibiotic prophylaxis in ECTR procedures. Patients undergoing dual-incision endoscopic carpal tunnel release at a single community hospital between May 1, 2018 and December 31, 2020 were enrolled in a pilot study. Subjects were randomized to prophylactic antibiotics or placebo saline solution arms. Infection rates and complications were compared. Study workflow processes were streamlined to facilitate eventual study duplication at additional sites. One hundred twenty-four subjects (140 hands) were included in the final analysis. No subjects in either study arm sustained an infection. The race and ethnic distributions of the study sample closely resembled those of the census-reported community distributions. Implementing a randomized, double-blind, placebo-controlled study at a community hospital presented numerous challenges. Although statistical nor clinical significance could be established in the absence of infection, these results validate what is presently known regarding the low likelihood of infection in clean hand surgery and demonstrated the feasibility of designing and implementing methodologically sound research in a community setting. Duplicating this study design at additional research sites can provide the level of evidence necessary to discourage unnecessary prophylactic antibiotic administration in clean hand surgery. • Surgical site infection following endoscopic carpal tunnel release is very low. • Prophylactic antibiotics may not be necessary in carpal tunnel procedures. • A randomized-controlled trial was successfully piloted at a community hospital. • This study design can be duplicated at more sites to obtain higher power.

Antibiotic selection and risk profiles in patients receiving antibacterial cardiovascular implantable electronic device envelopes – a real world sample and analysis

Abstract Background The use of a cardiovascular implantable electronic device (CIED) envelope impregnated with antibiotics provides short-term local antibiotic delivery in the implant pocket and may lower infection risk. Biologic antibacterial (BIO) envelopes, such as the porcine extracellular matrix (ECM) device hydrated with antibiotics, facilitate active remodeling of the pocket into vital, vascularized tissue and provide short-term local antibiotic delivery. Limited clinical data is available on real-world clinician patient selection criteria, antibiotic choices, or clinical outcomes. Purpose To explore antibiotic hydration solution physician choices with respect to patient profiles, and to determine post-implant infection outcomes in patients receiving a CIED BIO envelope. Methods A post-hoc sub-analysis of a multicenter, non-randomized study of 1017 patients receiving a biologic envelope (hydrated with or without antibiotics) during CIED procedures (SECURE Study) assessed antibiotic hydration choices, patient risk profiles, and the type and timing of infection for days 0–90 post procedure. Patient selection and antibiotic hydration choice were at the discretion of the treating physician. Results 850 patients received BIO envelopes, with a mean age of 71.9 years, and 60.5% having ≥2 standard infection risk factors. High power devices accounted for 47.6% and reoperations for 44.0% of the procedures. Antibiotic choice for envelope hydration prior to implantation is described in Table 1 below. Also, antibiotic combinations with gentamicin were used in 18.1% and other antibiotic combinations in 9.2% of patients. Patients receiving gentamicin hydrated BIO envelopes (BIO+G) trended toward fewer pocket infections vs. those without gentamicin (BIO-G) (0.0% vs. 1.6%, p=0.070) but the overall pocket infection rate of 1.2% was not significantly different based upon antibiotic choice. In a multivariate logistic regression model designed to predict the total infection rate, the use of gentamicin was associated with a 3-fold reduction in likelihood of infection, OR 3.0 (1.0–10.0); AUC=0.70. No differences in overall infection rates among patients undergoing lead or pocket revision only procedures (0.0% vs. 0.0%) or other major adverse events were observed based upon antibiotic usage. Conclusions Real world clinical decision-making regarding antibiotic choice for biologic antibacterial envelopes varies among implanting clinicians and influences observed outcomes. The use of biologic antibacterial envelopes hydrated with gentamicin was associated with a lower likelihood of infection within 90 days when compared to biologic envelopes hydrated without gentamicin. Clinical trials to optimize patient selection processes and determine the best antibiotic choice when employing a CIED envelope merit further investigation. Funding Acknowledgement Type of funding sources: Other. Main funding source(s): The work was supported by Aziyo Biologics, Inc. Table 1. BIO Envelope Hydration

Ticagrelor and Infection Risk in Patients with Coronary Artery Disease

Background: Ticagrelor has a bactericidal effect in vitro, and clinical studies suggest a beneficial effect in infections. Our aim was to determine the incidence of infections in patients treated with 3 different P2Y12 receptor inhibitors. Methods: Retrospective registry in a cardiology department. Patients with coronary artery disease discharged on ticagrelor, prasugrel, or clopidogrel from March 2017 to June 2019 were included. The risk of infection was analyzed during the period of P2Y12 inhibitor treatment (12.4 ± 6.7 months). Results: A total of 250 patients were included (ticagrelor 91 [36.4%], prasugrel 89 [35.6%], clopidogrel 70 [28.0%]). Mean age was 61.0 ± 13.1 years, and 63 (25.2%) were women. The most common reason to use these drugs was ST-segment elevation acute myocardial infarction (STEMI) (152 patients – 60.8%). STEMI was the reason to use prasugrel in 84 patients (94.4%), ticagrelor in 44 (48.4%), and clopidogrel in 24 (34.3%), p < 0.001. An infection during follow-up was seen in 87 patients (34.8%), 23 treated with ticagrelor (25.3%), 30 with prasugrel (33.7%) and 34 with clopidogrel (48.6%), p = 0.009. Ticagrelor was independently associated with a lower likelihood of infection (Hazard Ratio [HR] 0.52, 95% confidence interval [CI] 0.28–0.95; p = 0.035) compared to prasugrel (HR 0.96, 95% CI 0.54–1.73; p = 0.909) and clopidogrel (HR = 1). Conclusions: In patients admitted with coronary artery disease patients treated with ticagrelor had a lower frequency of infections during follow-up than those treated with other P2Y12 inhibitors. Further studies are necessary to clarify the bactericidal effect of ticagrelor in this context.

Unintended consequences of a reflex urine culture order set on appropriate antibiotic use.

We evaluated the impact of reflex urine culture screen results on antibiotic initiation. More patients with positive urine screen but negative culture received antibiotics than those with a negative screen (30.5 vs 7.1%). Urine screen results may inappropriately influence antibiotic initiation in patients with a low likelihood of infection.

Analysis of Regional Scale Risk of Whirling Disease in Populations of Colorado and Rio Grande Cutthroat Trout Using a Bayesian Belief Network Model

Introduction and spread of the parasite Myxobolus cerebralis, the causative agent of whirling disease, has contributed to the collapse of wild trout populations throughout the intermountain west. Of concern is the risk the disease may have on conservation and recovery of native cutthroat trout. We employed a Bayesian belief network to assess probability of whirling disease in Colorado River and Rio Grande cutthroat trout (Oncorhynchus clarkii pleuriticus and Oncorhynchus clarkii virginalis, respectively) within their current ranges in the southwest United States. Available habitat (as defined by gradient and elevation) for intermediate oligochaete worm host, Tubifex tubifex, exerted the greatest influence on the likelihood of infection, yet prevalence of stream barriers also affected the risk outcome. Management areas that had the highest likelihood of infected Colorado River cutthroat trout were in the eastern portion of their range, although the probability of infection was highest for populations in the southern, San Juan subbasin. Rio Grande cutthroat trout had a relatively low likelihood of infection, with populations in the southernmost Pecos management area predicted to be at greatest risk. The Bayesian risk assessment model predicted the likelihood of whirling disease infection from its principal transmission vector, fish movement, and suggested that barriers may be effective in reducing risk of exposure to native trout populations. Data gaps, especially with regard to location of spawning, highlighted the importance in developing monitoring plans that support future risk assessments and adaptive management for subspecies of cutthroat trout.

Benefit of In-Person Antibiotic Consultation in the ICU

In intensive care units (ICUs), many patients receive antibiotics, sometimes despite low likelihood of infection. Several previous reports have

4:10 PM Abstract No. 115 - Hematomas - to drain or not to drain, the interventionalist's dilemma

Purpose Determine outcomes associated with the percutaneous drainage of hematomas. Materials and Methods A retrospective analysis was performed of the last 50 drainages performed at this institution that had the appearance of bland blood products at drainage. 26 males and 24 females were included in the study with an age range of 14-90 and an average catheter placement time of 35 days. Evaluation of length of catheter drainage, need for reintervention, and outcomes were assessed. Results Of the 50 drainages in which fluid had the appearance of bland blood products expressed at drainage in the period between 8/2010- 2/2012, 41 had catheters placed. 9 were drained without catheter placement. Of the 9 in which a catheter was not placed, 0 had a positive culture. Of the 41 in which catheters were placed, 31 had positive cultures at analysis. 10 had negative cultures. Of the nine in which catheter placement was not performed 3 had minimal fluid aspirated, in 2 the clinician specifically requested no drain be placed, 1 was a liver lesion in which it was elected not to place a drain, and 3 were tiny collections in which the clinical services were requesting aspiration for culture only. All 50 were successfully drained by SIR criteria for diagnosis, with 46 patients resolving the clinical episode that precipitated drainage. Of these patients there were no serious complications associated with catheter placement, although 3 ultimately developed fistulas to bowel, pancreas, and biliary system, and the one death prior to catheter removal was related to multiorgan failure in a liver transplant patient perioperatively. Conclusion Hematoma drainage attempt may be warranted in most cases, given the very high association of bland appearing hematoma with positive culture (62%), and the frequency in which drainage was possible despite the collections appearing to contain only blood products(86%). In cases in which minimal fluid is returned from a collection that appears large enough to drain it may be appropriate to avoid catheter placement, as these collections may have a lower likelihood of infection.

High Prevalence of Genetically Similar HIV-1 Recombinants among Infected Sex Workers in Nairobi, Kenya

HIV-1, a highly diverse infectious agent, shows the greatest sequence diversity in highly exposed individuals, including greater levels of recombination. HIV-1 diversity in Nairobi, Kenya was examined in 240 individuals, including both those with high and low exposure to HIV. Sequence analysis of a 590 nucleotide proviral region encompassing vpu and part of env revealed that most viruses were clade A1 (70%), while both clade D (9%) and clade C (6%) virus were also observed, as was recombinant virus (15%). Participation in sex work was significantly associated with clade: these subjects had a lower likelihood of infection with clade C virus and a higher likelihood of infection with a recombinant isolate (p = 0.038). Interestingly, most of the recombinants formed distinct groups based on shared recombination breakpoints between common clades (n = 33/37). This study shows the value of continued HIV sequence analysis to examine and monitor viral genetic variability.

The epidemiology of candidaemia and mould infections in Australia.

A retrospective review of Candida bloodstream infections (BSI) in Australian hospitals between 1995 and 1998 was performed. Nine tertiary referral hospitals in the States of New South Wales, Victoria, South Australia and Queensland participated. Of all isolates, 56% were Candida albicans, 14% Candida parapsilosis, 13% Candida glabrata, 5% Candida krusei and 4.5% Candida tropicalis. There were significant differences in the distribution of species in different patient groups. Among surgical patients, 69% of candidaemia was due to C. albicans, whereas among medical patients the proportion was 52%, and in haematology patients 43% (P = 0.0012; Pearson chi(2)). BSI with C. krusei were almost exclusive to haematology patients and were the second leading cause of Candida infection in that group, accounting for 27% of infections. The temporal pattern of Candida isolates also revealed a relationship between the latter years of the study and a lower likelihood of infection with C. albicans. Logistic regression showed year of the study [P = 0.032; odds ratio (OR) 0.81; 95% confidence interval (CI) 0.67-0.98] and surgery (P = 0.005; OR 2.02; 95% CI 1.2-3.1) to be significant variables. The rate of candidaemia in Australian hospitals was similar to that reported for US hospitals at 0.1-0.27 per 1000 discharges. Since April 1998, the clinical database on the internet resource Mycology Online has invited submission of clinical details from cases of invasive mycoses from Australian clinicians. To date, descriptions of 43 patients with proven or presumptive mould infection have been entered on the database. Of these, the leading cause was infection with Aspergillus (n = 16), followed by Zygomycetes (n = 7), Fusarium (n = 5), Scedosporium (n = 5) and Exserohilum (n = 1). Although Aspergillus infections were the most frequent on the database, the variety of mould infections seen in this short time was surprising. A knowledge of local patterns of infection and antifungal susceptibility is useful in selecting empirical therapy and formulating prophylactic and pre-emptive strategies.

Clinician judgement as a tool for targeting HIV counseling and testing in North Carolina state mental hospitals, 1994.

HIV infection increasingly affects populations that may not appear at high risk based on the use of some traditional targeting strategies. To shed some light on how to more sensitively/effectively identify people who need routine HIV testing and counseling, the objective of this study is to determine the prevalence of HIV infection in North Carolina state mental hospitals and to evaluate clinician judgment as a tool for targeting HIV counseling and testing. The design used is a blinded seroprevalence study. The study population includes all patients admitted to North Carolina state mental hospitals between March 1st and May 31st, 1994. The main outcome measures are the HIV seroprevalence, demographic and diagnostic features, and clinician assessment of the likelihood of HIV infection. The results of the study find that of 2159 study subjects, 35 persons (1.6%) were infected with HIV; of these, 14 (40%) were not previously known to be infected. All 35 HIV infections occurred in persons aged 13-59 years. Within this age group, infection rates were significantly higher for Blacks, males, persons who had a diagnosis of organic brain disease, and persons who had multiple psychiatric diagnoses. However, testing strategies that targeted any of the higher risk groups were insensitive. The rate of HIV infection for persons judged by the admitting clinician to have a high or intermediate likelihood of HIV infection was 26.4 times higher than the rate for those judged to have a low likelihood of infection (2.1 vs. 0.1%, 95% confidence intervals: 3.5-201.3). Of the 14 previously undiagnosed HIV-infected persons, 13 were judged by clinicians to have a high or intermediate likelihood of HIV infection. Moreover, 1258 persons were correctly assessed to have a low likelihood of infection. Conclusions from this study are that an HIV counseling and testing strategy targeting persons (in this setting aged 13-59 years) who were judged by clinicians to have a high or intermediate likelihood of infection, would have identified more than 90% of previously undetected infections while substantially reducing the number of negative HIV tests performed.

ATROPELLIS CANKER OF LODGEPOLE PINE: ETIOLOGY, SYMPTOMS, AND CANKER DEVELOPMENT RATES

The reproductive structures of Atropellis piniphila (Weir) Lohman and Cash are described from material collected on lodgepole pine in Alberta. Conidia probably precede apothecia. They are produced endogenously and are released in a mucilaginous exudate when the fructifications are wet. Inoculations and subsequent reisolations provide strong evidence of the pathogenicity of A. piniphila, although only a few of the inoculations were successful.The pathogen entered through undamaged bark, and most stem infections originated on stems at branch nodes. Some stem cankers originated as branch infections in a stand where the lower branches were alive, but none originated in this way where live branches were restricted to the upper crown. In stands with large amounts of inoculum, the likelihood of stem tissues becoming infected changed as tissues grew older. An initial period of very low likelihood of infection was succeeded by one of high likelihood, and this in turn by a period of low likelihood.The development of symptoms is described, and the rates of longitudinal and tangential development of cankers are given.