Predictors Of Fatality Research Articles

TB case fatality and recurrence in a private sector cohort in Mumbai, India

SUMMARYBACKGROUND:Half of India’s three million TB patients are treated in the largely unregulated private sector, where quality of care is often poor. Private provider interface agencies (PPIAs) seek to improve private sector quality of care, which can be measured in terms of case fatality and recurrence rates.METHODS:We conducted a retrospective cohort survey of 4,000 private sector patients managed by the PATH PPIA between 2014 and 2017. We estimated treatment and post-treatment case-fatality ratios (CFRs) and recurrence rates. We used Cox proportional hazards models to identify predictors of fatality and recurrence. Patient loss to follow-up was adjusted for using selection weighting.RESULTS:The treatment CFR was 7.1% (95% CI 6.0–8.2). At 24 months post-treatment, the CFR was 2.4% (95% CI 1.7–3.0) and the recurrence rate was 1.9% (95% CI 1.3–2.5). Treatment fatality was associated with age (HR 1.02, 95% CI 1.02–1.03), clinical diagnosis (HR 0.61, 95% CI 0.45–0.84), treatment duration (HR 0.09, 95% CI 0.06–0.10) and adherence. Post-treatment fatality was associated with treatment duration (HR 0.87, 95% CI 0.79–0.91) and adherence.CONCLUSIONS:We found a moderate treatment phase CFR among PPIA-managed private sector patient with low rates of post-treatment fatality and recurrence. Routine monitoring of patient outcomes after treatment would strengthen PPIAs and inform future post TB interventions.

Case fatality and recurrent tuberculosis among patients managed in the private sector: A cohort study in Patna, India.

BackgroundA key component of the WHO End TB Strategy is quality of care, for which case fatality is a critical marker. Half of India’s nearly 3 million TB patients are treated in the highly unregulated private sector, yet little is known about the outcomes of these patients. Using a retrospective cohort design, we estimated the case fatality ratio (CFR) and rate of recurrent TB among patients managed in the private healthcare sector in Patna, India.MethodsWorld Health Partners’ Private Provider Interface Agencies (PPIA) pilot project in Patna has treated 89,906 private sector TB patients since 2013. A random sample of 4,000 patients treated from 2014 to 2016 were surveyed in 2018 for case fatality and recurrent TB. CFR is defined as the proportion of patients who die during the period of interest. Treatment CFRs, post-treatment CFRs and rates of recurrent TB were estimated. Predictors for fatality and recurrence were identified using Cox proportional hazards modelling. Survey non-response was adjusted for using inverse probability selection weighting.ResultsThe survey response rate was 56.0%. The weighted average follow-up times were 8.7 months in the treatment phase and 26.4 months in the post-treatment phase. Unobserved patients were more likely to have less than one month of treatment adherence (32.0% vs. 13.5%) and were more likely to live in rural Patna (21.9% vs. 15.0%). The adjusted treatment phase CFR was 7.27% (5.97%, 8.49%) and at 24 months post-treatment was 3.32% (2.36%, 4.42%). The adjusted 24 month post-treatment phase recurrent TB rate was 3.56% (2.54%, 4.79%).ConclusionsOur cohort study provides critical estimates of TB patient outcomes in the Indian private sector, and accounts for selection bias. Patients in the private sector in Patna experienced a moderate treatment CFR but rates of recurrent TB and post-treatment fatality were low.

Changes in antimicrobial resistance and outcomes of health care-associated infections.

To describe the change in the epidemiology of health care-associated infections (HAI), resistance and predictors of fatality we conducted a nationwide study in 24 hospitals between 2015 and 2018. The 30-day fatality rate was 22% in 2015 and increased to 25% in 2018. In BSI, a significant increasing trend was observed for Candida and Enterococcus. The highest rate of 30-day fatality was detected among the patients with pneumonia (32%). In pneumonia, Pseudomonas infections increased in 2018. Colistin resistance increased and significantly associated with 30-day fatality in Pseudomonas infections. Among S. aureus methicillin, resistance increased from 31 to 41%.

Road traffic accident fatality predictors: A case–control study in Isfahan

Road traffic accident fatality predictors: A case–control study in Isfahan

Mortality related to drug-resistant organisms in surgical sepsis-3: an 8-year time trend study using sequential organ failure assessment scores

The difference in sequential organ failure assessment (SOFA) scores from the baseline to sepsis is a known predictor of sepsis-3 outcome, but the prognostic value of drug-resistant organisms for mortality is unexplained. We employed sepsis stewardship and herein report an observational study. Study subjects were patients admitted to the Departments of Surgery/Chest Surgery from 2011 through 2018 with a diagnosis of sepsis and a SOFA score of 2 or more. Our sepsis stewardship methods included antimicrobial and diagnostic stewardship and infection control. We determined the primary endpoint as in-hospital death and the secondary endpoint as the annual trend of the risk-adjusted mortality ratio (RAMR). For mortality, we performed logistic regression analysis based on SOFA score, age, sex, comorbid disease, and the presence of methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase inhibitor–producing bacteria. In a total of 457 patients, two factors were significant predictors for fatality, i.e., SOFA score of 9 or more with an odds ratio (OR) 4.921 and 95% confidence interval [95% CI] 1.968–12.302 (P = 0.001) and presence of MRSA with an OR 1.83 and 95% CI 1.003–3.338 (P = 0.049). RAMR showed a decrease during the study years (P < 0.05). Early detection of MRSA may help patients survive surgical sepsis-3. Thus, MRSA-oriented diagnosis may play a role in expediting treatment with anti-MRSA antimicrobials.

Tetanus in School Age Children Seen at the University of Port Harcourt Teaching Hospital: A Need for Booster Doses of Tetanus Vaccine

Background: Tetanus still causes significant morbidity and mortality amongst children in Nigeria despite decades of immunisation with tetanus vaccine.&#x0D; Objectives: To determine the prevalence, case fatality rate and predictors of fatality amongst school age children treated for tetanus at the University of Port Harcourt Teaching Hospital.&#x0D; Materials and Methods: This was a retrospective study of all children aged 4 to 17 years treated for tetanus at the University of Port Harcourt Teaching Hospital between January 1, 2009 and December 31, 2019. Data was obtained from the case notes and ward registers. Socio-demographic characteristics, presenting complaints, incubation period, onset interval, number of Diphtheria, Pertussis and Tetanus (DPT) vaccine received at infancy, treatment outcome, duration and cost of hospital stay were obtained, entered into a spread sheet and analysed with SPSS version 20. Results are presented in tables and percentages. The level of significance was set at P value &lt;0.05.&#x0D; Results: During the period under review, there were 53 children aged 4 to 17 years treated for tetanus, accounting for 0.3% of the total admission. The mean age was 10.79±3.35 years. There were 33 (62.26%) males and 20 (37.74%) females. Majority 26 (49.06%) of the children were of low socioeconomic class. The commonest 28(52.8%) route of infection was broomstick injury. Majority 32(60.3%) of the children were not immunised in infancy. The mean incubation period was 7.34±4.21 days and the mean onset interval was 8.87±10.44 hours. The two most common symptoms were generalized spasms 49 (21.03%) and trismus 47 (20.17%). Short incubation period (≤4 days) and short onset interval (≤4 hours) were significantly associated with higher death rates (p=0.0002; p=0.012). Patients with short incubation period of ≤4 days and short onset interval of≤ 4 hours are more likely to die (p=0.0002; p=0.012).&#x0D; Conclusion: There was a high tetanus case fatality rate amongst school age children at University of Port Harcourt. Short incubation period and onset interval were associated with higher mortality. Booster doses of TT containing vaccines should be administered to primary and secondary school children in Port Harcourt to curb the menace.

Baseline High-Sensitive-Cardiac Troponin I as a Predictor of Fatality in Stable Chronic Heart Failure Patients in Nigeria

Background: The prognostic value of high-sensitive-cardiac troponin I (hs-cTnI), a biomarker for heart failure (HF), has been well studied in developed countries. However, its significance in patients with chronic HF (CHF) in Nigeria and Africa at large remains unknown. Methods: This was a hospital-based prospective study. Sixty-four consecutive consenting patients with clinical and echocardiographic evaluation for HF attending cardiology clinic were recruited. They all had resting 12-lead electrocardiogram done. Blood sample for serum hs-cTnI assay (enzyme-linked immunosorbent assay), electrolytes, urea, and creatinine was obtained at recruitment and at 6 months. The participants were followed up monthly for 6 months from baseline to determine the case fatality rate and hospitalization rate. Results: At the end of 6 months, four patients were lost to follow-up. Eight participants died of HF-related cause and had statistically significantly higher mean recruitment serum hs-cTnI levels than the survivors (0.35 ± 0.05 ng/ml vs. 0.23 ± 0.02 ng/ml),P ≤ 0.001. Baseline hs-cTnI ≥0.25 ng/ml was found to be an independent significant prognostic predictor of HF fatality on Cox regression analysis. Conclusions: This study demonstrated that hs-cTnI was predictive of HF fatality in a cohort of patients with CHF in Nigeria. Thus, it may be used to risk stratify patients as a guide to identify those likely to benefit from more aggressive management.

Clinical and Biochemical Predictors of Fatality in Traumatic Brain Injury

Traumatic brain injury is a global health problem, it is a major cause of devastating neurological sequelae and significant mortality. The underlying physiological events in traumatic brain injury are responsible for the poor clinical outcomes seen in patients. Inflammatory and oxidative stress changes in traumatic brain injury result in the release of inflammatory biomarkers, a reduction in the endogenous anti-oxidants and dysfunction of the blood brain barrier. An understanding of the natural history of oxidative stress and inflammatory changes in traumatic brain injury can help design appropriate management protocols to reduce mortality and morbidity in these patients. Aim of the study: The aim of this study was to identify potential biomarkers that are predictive of fatality in patients with moderate to severe traumatic brain injury. Methods: This was a prospective study of patients with moderate to severe traumatic brain injury managed at the Nelson Mandela Academic Hospital during the period March 2014 - March 2016. Following admission and management, the patient demographics (sex, age) and admission Glasgow Coma Score were recorded. Oxidative stress and inflammatory biomarkers in blood and cerebrospinal fluid where sampled on day 1 to 7. On day 14 only blood was sampled for the same biomarkers. The primary outcome was the Glasgow Outcome score assessed on day 90. Due to its simplicity the Glasgow Outcome scale was used to assess clinical outcomes at day 90. Because of difficulty in regular follow up due to the vastness of our region, difficult terrain and long travel distances a 3 month follow up period was used to avoid default. Results: Of the 64-patient’s, fatality was noted in 12.5% of them. There was a significant association between fatality and the; ages of the patients, anti-oxidant levels, proinflammatory biomarkers and admission Glasgow Coma Score. Conclusion: The admission Glasgow Coma Score, low anti-oxidant levels and elevated serum interleukin-1β levels were associated with fatal outcomes.

Equestrian-related injuries, predictors of fatalities, and the impact on the public health system in Sweden

ObjectivesHorse riding is a popular activity but has also been found to lead to many injuries and even fatalities. No reduction in the numbers of those being admitted to hospital for equestrian-related injuries have been seen in Sweden in recent years. The aim of this work was to examine injuries, fatalities, and predictors of fatalities in equestrian-related activities and to investigate the cost of these injuries to the public health system. Study designThe study is a retrospective analysis of hospital data. MethodsNational Swedish hospital and mortality registers were retrospectively examined, inclusive of the years 1997–2014. Logistic regression was used to examine the predictors of fatal injuries, and cost of hospital treatment was considered. ResultsOver the study period, there were an observed 29,850 injured cases and 51 fatalities. Women comprized almost 90% of those injured and 70% of fatalities. The average age was 26.8 years (range 0–91, standard deviation [SD] = 16.1) for injured and 43 years (range 7–78 years, SD = 20.5) for fatal cases. Men dominated both injured and fatal samples in the older age ranges (Fatal: >50 years; Injured: >70 years), although overall numbers were small. Injuries to the head contributed more than any other body region for both injured and fatal cases, and fractures were the most frequently seen injury type. A chi-squared analysis confirmed that injury type and injured body region were not independent of age. Logistic regression examining the association between fatality and age, gender, home region, and year of injury, indicating trends over time, found that there was an increase of 5.1% in the odds of fatality for every year increase in age of the patient and men had 2.2 times higher odds to be in the fatal sample than women. The conservative estimated cost of injury was 1800 Euro per injury event, equating to over 3 million Euro per year. ConclusionEquestrian-related injury events present a major public health concern. Observed decreases in fatalities suggest improved health care, yet head injury and fatality rates are still high, indicating a need for further intervention. The type of injury changes with the age group, and a better understanding of injury patterns with age is needed to identify protective measures for the different user groups.

Predictors of fatality in influenza A virus subtype infections among inpatients in the 2015–2016 season

BackgroundInfection with the influenza A virus can cause severe disease and mortality. The effect of the different subtypes of influenza on morbidity and mortality is not yet known in Turkey. The aim of this study was to describe the predictors of fatality related to influenza A infection among hospitalized patients in Istanbul during the 2015–2016 influenza season, and to detail the differences between infections caused by H3N2 and H1N1. MethodsThis was a multicenter study performed by the Istanbul Respiratory Infections Study Group of The Turkish Society of Clinical Microbiology and Infectious Diseases (KLİMİK), among patients hospitalized for influenza in Istanbul during the 2015–2016 influenza season. ResultsA total of 222 patients hospitalized with laboratory-confirmed influenza during the 2015–2016 season were included in the study, of whom 25 (11.2%) died. The fatality rate was significantly higher among patients older than 65 years of age and those with chronic heart and kidney diseases (p<0.001), chronic neurological diseases (p=0.009), and malignancies (p=0.021). Thrombocyte counts were lower in those who died than in those who survived (p<0.004). The median alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, creatinine phosphokinase, and C-reactive protein levels were higher among fatal cases. In the multivariate analysis for the prediction of fatality, being >65years old (odds ratio (OR) 6.9, 95% confidence interval (CI) 2.07–23.08, p=0.002), being infected with influenza A(H3N2) (OR 4.2, 95% CI 1.27–14.38, p=0.019), and a 1-day delay in antiviral use (OR 1.28, 95% CI 1.01–1.63, p=0.036) were found to be associated with an increased likelihood of fatality. ConclusionsThe case fatality rate of influenza A(H3N2) was significantly higher than that of influenza A(H1N1). Detection of the infection, allowing the opportunity for the early use of antiviral agents, was found to be important for the prevention of fatality. The vaccination should be prioritized for at-risk groups.

Evaluation of Hypothermia in Sick Neonates as Predictor of Fatality at a Tertiary Care Center of Eastern Nepal

Introduction: Hypothermia is a common and frequent problem in newborns. It has larger impact in outcome related to management of sick infants.Objective: To correlate the severity of hypothermia in sick extramural neonates with fatality and physiological derangements.Materials and Methods: This prospective observational study was carried out at Neonatology unit of Pediatric department of B. P. Koirala Institute of Health Sciences (BPKIHS) Dharan. Total 200 extramural hypothermic neonates were transferred to BPKIHS from June 2015 to June 2016. Neonates weighing more than 1000 g, with abdominal skin temperature less than 36.5°C at admission were included in the study.. Clinical features and associated features were recorded at the time of admission. Oxygen saturation was recorded by a pulse oximeter.Results: Fatality was observed to be 39.3% in mildly hypothermic babies, 51.6% in moderately hypothermic babies and 80% in severely hypothermic babies. However, the presence of associated illness (birth asphyxia, neonatal sepsis and respiratory distress), physiological derangements (hypoxia, hypoglycemia and shock) and weight less than 2000 g were associated with more than 50% fatality even in mildly hypothermic babies. When moderate hypothermia was associated with hypoxia or shock, the fatality was 83.3% and 90.9%, respectively. Similarly, mild hypothermia with hypoglycemia was associated with 71.4% fatality.Conclusion: The presence of associated illness (birth asphyxia, neonatal sepsis and respiratory distress), physiological derangements (hypoxia, hypoglycemia and shock) and weight less than 2000 g should be considered adverse factors in hypothermic neonates. Their presence should classify hypothermia in the next higher category of severity in WHO classification. JNGMC Vol. 14 No. 2 December 2016, page: 8-11

Abstract WP317: Early and Late Vascular Events and Fatality amongst Transient Ischemic Attack Hospitalization

Background: Risk of acute ischemic stroke (AIS) or an acute coronary syndrome was 12 to 20% during the first 3 months after a transient ischemic attack (TIA) or minor stroke. We aimed to find out early vascular events (EVEs) and late vascular events (LVEs) [AIS, hemorrhagic stroke (HS), myocardial infarction (MI), angina, and atrial fibrillation (AFib)], outcomes, and predictors of fatality in TIA hospitalization. Methods: We performed a retrospective analysis of Nationwide Inpatient Sample (years 2007-2014) in adult hospitalizations for TIA to find out EVEs and with past medical history (PMH) of TIA to find out LVEs using ICD-9-CM codes. We performed analyses using Chi-square to compare the outcomes (Death, Risk of Death, Loss of Function, and poor Discharge Disposition) amongst EVEs and LVEs. Multivariate survey logistic regression was done to evaluate the outcomes and predictors of fatality. Results: From years 2007 to 2014, total 11,776,757 (TIA: 1,948,818; PMH TIA: 9,827,939) patients with TIA were hospitalized. LVEs were more common in TIA patients except for HS. LVEs were associated with the significantly higher mortality (2.8% vs 0.6%; aOR: 4.22; 95% CI: 3.97-4.48) and poor overall outcomes in compare to EVEs (Table). Independent predictors of fatality were AIS (aOR: 3.03; 95% CI: 2.75-3.34), HS (aOR: 3.74; 95%CI: 3.25-4.31), MI (aOR: 3.52; 95% CI: 3.30-3.75), and AFib (aOR: 1.32; 95% CI: 1.28-1.37). Other predictors with higher odds of fatality were age &gt;65, Asian and Pacific Islander, male, weekend admissions, peripheral vascular disease, CHF, renal failure, coagulopathies, and alcohol abuse (Table). Conclusion: Following TIA, patients could be at risk of many vascular events and not an only stroke. We observed poor outcomes amongst patients of TIA with LVEs. Identification of such patients, long term risk stratification, and secondary prevention through regular follow-up play a very crucial role to identify patients at risk to prevent LVEs following TIA.

Predictors of fatality in pandemic influenza A (H1N1) virus infection among adults.

BackgroundThe fatality attributed to pandemic influenza A H1N1 was not clear in the literature. We described the predictors for fatality related to pandemic influenza A H1N1 infection among hospitalized adult patients.MethodsThis is a multicenter study performed during the pandemic influenza A H1N1 [A(H1N1)pdm09] outbreak which occurred in 2009 and 2010. Analysis was performed among laboratory confirmed patients. Multivariate analysis was performed for the predictors of fatality.ResultsIn the second wave of the pandemic, 848 adult patients were hospitalized because of suspected influenza, 45 out of 848 (5.3%) died, with 75% of fatalities occurring within the first 2 weeks of hospitalization. Among the 241 laboratory confirmed A(H1N1)pdm09 patients, the case fatality rate was 9%. In a multivariate logistic regression model that was performed for the fatalities within 14 days after admission, early use of neuraminidase inhibitors was found to be protective (Odds ratio: 0.17, confidence interval: 0.03-0.77, p = 0.022), nosocomial infections (OR: 5.7, CI: 1.84-18, p = 0.013), presence of malignant disease (OR: 3.8, CI: 0.66-22.01, p = 0.133) significantly increased the likelihood of fatality.ConclusionsEarly detection of the infection, allowing opportunity for the early use of neuraminidase inhibitors, was found to be important for prevention of fatality. Nosocomial bacterial infections and underlying malignant diseases increased the rate of fatality.

Epidemiology of Bordetella pertussis in a children‘s hospital

Pertussis or whooping cough continues to be a major cause of morbidity and mortality in infants younger than 1 year old. To describe the clinical and epidemiological profile of Bordetella pertussis and to analyze the factors associated with confirmation by PCR and case fatality rate. Prospective, cohort study conducted between December 2003 and December 2011. The study included children seen at the Hospital de Niños Ricardo Gutiérrez suspected of pertussis. The factors associated with confirmation by PCR and the case fatality rate by relative risk (RR) with a 95% confidence interval were studied. Six hundred and twenty patients with a 38% of positive cases (236/620) were included, 3 cases were confirmed by epidemiological link. Confirmed cases (239) showed a seasonal pattern from September through February, a median age of 3 months old, and 89% had received less than three vaccine doses. Eighty six percent of patients were hospitalized: their median length of stay was 7 days. A total of 99% of patients were eu-trophic, 98% were immunocompetent and 17.5% required intensive care. The clinical presentation was analyzed in 480 patients. Of them, 38% (184) had a positive PCR result and their symptoms were: 96.2%, cough; 76.5%, paroxysmal cough; 57.9% cyanosis; 55.7%, respiratory distress; 29%, fever; 22.4%, apnea; 21.9%, vomiting after coughing. A multivariate analysis identified the following as independent predictors associated with confirmation of pertussis by PCR: paroxysmal cough (OR 2.52: 1.50-4.22; p= 0.000) and leukocytosis upon admission >20 000 white blood cells/mm3 (OR 7.96: 4.82-13.17; p= 0.000); having developed fever reduced the chance of having a positive PCR result (OR 0.47: 0.29-0.77; p= 0.003). The case fatality rate for hospitalized patients was 6.8%. Leukocytosis >30 000 white blood cells/mm3 was a predictor of fatality (RR 6.7: 1.88-23.9; p= 0.001). Confirmed cases were mostly infants younger than 1 year old who were healthy before and who had not completed their primary immunization schedule. Paroxysmal cough and leukocytosis were associated with PCR diagnosis, while leukocytosis was a predictor of mortality.

HIV-Associated Central Nervous System Disease in Patients Admitted at the Douala General Hospital between 2004 and 2009: A Retrospective Study

Background. Studies on HIV-associated central nervous system (CNS) diseases in Cameroon are rare. The aim of this study was to describe the clinical presentation, identify aetiological factors, and determine predictors of mortality in HIV patients with CNS disease. Methods. From January 1, 2004 and December 31, 2009, we did at the Douala General Hospital a clinical case note review of 672 admitted adult (age ≥ 18 years) HIV-1 patients, and 44.6% (300/672) of whom were diagnosed and treated for HIV-associated CNS disease. Results. The mean age of the study population was 38.1 ± 13.5 years, and median CD4 count was 49 cells/mm3 (interquartile range (QR): 17–90). The most common clinical presentations were headache (83%), focal signs (40.6%), and fever (37.7%). Toxoplasma encephalitis and cryptococcal meningitis were the leading aetiologies of HIV-associated CNS disease in 32.3% and 25% of patients, respectively. Overall mortality was 49%. Primary central nervous system lymphoma (PCNSL) and bacterial meningitis had the highest case fatality rates of 100% followed by tuberculous meningitis (79.8%). Low CD4 count was an independent predictor of fatality (AOR: 3.2, 95%CI: 2.0–5.2). Conclusions. HIV-associated CNS disease is common in Douala. CNS symptoms in HIV patients need urgent investigation because of their association with diseases of high case fatality.

Liver abscesses in adult patients with and without diabetes mellitus: an analysis of the clinical characteristics, features of the causative pathogens, outcomes and predictors of fatality: a report based on a large population, retrospective study in China

In China, there are four types of liver abscesses (LAs) that meet the clinical criteria. Pyogenic liver abscesses (PLAs) and amoebic liver abscesses (ALAs) are two of the most common types of abscesses, followed by fungal liver abscesses (FLAs) and hydatid secondary liver abscesses (HsLAs). Diabetes mellitus (DM) is associated with the development of PLAs. However, there is a lack of population-based studies that have evaluated the underlying relationship between LAs (mainly PLAs and FLAs) and DM. We conducted a retrospective study based on a large population to identify the potential differences and factors that affect the mortality of PLA patients in DM and non-DM groups. Our results revealed that the prevalence of DM is 44.3% (158/357) in PLA patients and 35.3% (18/51) in FLA patients. Compared with the non-DM patients, statistically significant differences were found in DM patients according to symptomatology, clinical manifestations, laboratory findings, microbiological characteristics, antimicrobial resistance, clinical treatments and outcomes in relation to mortality. In addition, the status of antibiotic resistance to E. coli and K. pneumoniae, which were isolated from the patient samples, is severe in the area in which the study was conducted. Regarding the treatment of PLAs, our study indicated that broad-spectrum antimicrobial therapy and drug combinations should be recommended and initiated before the pathogens are cultured and identified. In the clinic, therapies that combine percutaneous drainage with antibiotics and surgery with antibiotics are the two most useful strategies for treating an LA. These two combined treatments resulted in satisfactory cure rates. In the DM and non-DM groups, the cure rates for percutaneous drainage with antibiotics were 90.3% and 92.0%, respectively, and the cure rates for surgery with antibiotics were 93.9% and 95.2%, respectively.

Kırım-Kongo Kanamalı Ateş Virüs Enfeksiyonu: Klinik ve Laboratuvar Gözlemleri ve Fatalitenin Öngördürücüleri

Objective: Objectives: In this study we described the predictors of fatality among Crimean-Congo hemorrhagic fever (CCHF) patients who admitted to our hospital based on epidemiological, clinical and laboratory findings between 2005 and 2006. Material and Methods: Definitive diagnosis was based on the detection of CCHF virus-specific IgM by ELISA and/or of genomic segments of the CCHF virus by real time polymerase chain reaction. Related data were collected prospectively. Results: The study included 63 patients. Thirty-two of the patients (50.8%) were females and 31 of them (49.2%) were males. The overall case fatality rate was 4.8 %. The age and sex were similar between favorable and fatal cases (p>0.05). The mean duration to the onset of symptoms for all patients was 4.7 days and differences in the mean duration to the onset of symptoms between surviving and died patients were not statistically significant (p=0.22). Weakness, myalgia, somnolence, bleeding from multiple sites and presence of petechia/ecchymosis were observed more often in the patients who died (p=0.02, p=0.03, p=0.015, p=0.02, respectively). Significant elevation of LDH levels (p=0.004), prolonged APT (p=0.004), prolonged PT (p=0.04) and thrombocytopenia (p=0.01) were detected in patients who died. Oral ribavirin was prescribed to 46 patients (73%). Prescription of ribavirin was considered to three patients with fatal disease, but this could not be realized because of hematemesis and melena. Conclusion: The existence of various clinical and laboratory findings like weakness, myalgia, somnolence, bleeding, elevation of LDH levels, prolonged APT and PT and thrombocytopenia may be considered as risk factors for fatality in CCHF.

Biofilm production, use of intravascular indwelling catheters and inappropriate antimicrobial therapy as predictors of fatality in Chryseobacterium meningosepticum bacteraemia

Chryseobacterium meningosepticum usually causes infections in neonates and the immunocompromised. Treatment is handicapped by the organism's inherent multidrug resistance. In this study, the clinical characteristics of patients with C. meningosepticum bloodstream infection (BSI) were retrospectively reviewed. Antimicrobial susceptibilities of the clinical isolates were analysed and their ability to form biofilm was assayed by crystal violet staining and electron microscopy. During 2003–2007, 40 patients with BSI caused by C. meningosepticum were included. Mean patient age was 61.6 ± 22.1 years. Co-morbidities were observed in 38 cases (95.0%) and a high 14-day mortality (52.5%) was observed in these patients. Susceptibility of the isolates was relatively high (>50%) only to piperacillin, piperacillin/tazobactam, trimethoprim/sulfamethoxazole and ciprofloxacin. Multivariate analysis revealed that mortality was associated with the use of central venous catheters, initial inappropriate antimicrobial therapy and higher biofilm production by the organism. Electron microscopy confirmed the formation of biofilm microcolonies on the solid phase of the fibre of nitrocellulose paper in vitro. Time–kill studies showed that biofilm formation helps bacteria to tolerate killing by ciprofloxacin. In conclusion, C. meningosepticum is a biofilm-forming organism. The outcome of patients with biofilm-forming C. meningosepticum infection was adversely affected by the choice of inappropriate antimicrobial therapy and the use of long-term indwelling intravascular catheters.

Characteristics of Pyogenic Liver Abscess Patients With and Without Diabetes Mellitus

Pyogenic liver abscess (PLA) is relatively common in patients with diabetes mellitus (DM), but it is unclear whether there are differences between patients with and without DM. We conducted a study to identify the possible differences and factors that affect fatality. We included PLA patients treated at a medical center from April 2001 to March 2004 and compared the clinical characteristics of patients with and without DM. We applied chi-square, Fisher's exact, and t-tests to evaluate the differences between the two groups and used logistic regressions to identify predictors of fatality. Of the 377 patients included, 182 (48.3%) had DM. Patients with DM had higher prevalence rates of cryptogenic etiology, gas-forming nature, thrombocytopenia, hyperglycemia, growth of Klebsiella pneumonia in blood cultures, metastatic infection, and bacteremia, but lower prevalence rates of biliary origin, right upper quadrant pain, and growth of Escherichia coli in pus cultures. Whereas creatinine >1.3 mg/dl (adjusted odds ratio (OR) 7.3, 95% confidence interval (CI) 2.2-24.5) and gas-forming nature (adjusted OR 9.4, 95% CI 3.0-24.5) were predictors of fatality, DM was not. We discovered that C-reactive protein and neutrophil were good biomarkers of PLA, but not asparate aminotransferase and alanine aminotransferase. PLA patients with and without DM have different clinical characteristics, but DM is not a predictor of fatality. We have identified several biomarkers that might help reduce the misdiagnosis of PLA.

Predictors of Fatality in Postdiarrheal Hemolytic Uremic Syndrome

Predictors of Fatality in Postdiarrheal Hemolytic Uremic Syndrome