Risk Factors For Recurrent Infection Research Articles

Effect of Different Induction Immunosuppression on the Incidence of Infectious Complications after Kidney Transplantation-Single Center Study.

Background/Objectives: Potent immunosuppression lowers the incidence of acute graft rejection but increases the risk of infections. In order to decrease either infectious complications or acute rejection, it is necessary to identify risk groups of patients profiting from personalized induction immunosuppressive treatment. The aim of our analysis was to find whether there were higher incidences of infectious complications after kidney transplantation (KT) in groups with different induction immunosuppressive treatment and also to find independent risk factors for recurrent infections. Materials: We retrospectively evaluated all patients with induction treatment with basiliximab after kidney transplantation from 2014 to 2019 at our center relative to age- and sex-matched controls of patients with thymoglobulin induction immunosuppression. Results: Our study consisted of two groups: basiliximab (39) and thymoglobulin (39). In the thymoglobulin group we observed an increased incidence of recurrent infection in every observed interval; however, acute rejection was seen more often in the basiliximab group. A history of respiratory diseases and thrombocytopenia were identified as independent risk factors for recurrent bacterial infections from the first to sixth month after KT. Decreased eGFR from the first month, infections caused by multi-drug-resistant bacteria, and severe infections (reflected by the need for hospitalization) were identified as independent risk factors for recurrent bacterial infections from the first to the twelfth month after KT. Conclusions: We found that in the group of patients with thymoglobulin induction immunosuppressive treatment, infectious complications occurred significantly more often during the entire monitored period with decreased incidence of acute humoral and cellular rejection occurred more often.

Treatment of Fracture-Related Infection after Pelvic Fracture.

The management of pelvic fractures is a significant challenge. Surgical site infection can result in the need for revision surgery, cause functional impairment, and lead to a prolonged length of stay and increased treatment costs. Although reports on fracture-related infection (FRI) after pelvic fracture fixation are sparsely reported in the literature, it is a serious complication. This study analysed patients with FRIs after pelvic fracture regarding patient characteristics, treatment strategies, and an evaluation of risk factors for FRI. In this retrospective single-centre study, FRI was diagnosed based on clinical symptoms of infection and a positive culture of a bacterial infection. Depending on the severity and acuteness of the infection, osseous stabilization was restored either via implant retention (stable implant, no osteolysis), exchange (loose implant or bony defect), or external fixation (recurrence of infection after prior implant retaining revision). Healing of infection was defined as no sign of recurring infection upon clinical, radiological, and laboratory examination in the last follow-up visit. The FRI rate in our patient population was 7.5% (24/316). In 8/24 patients, the FRI occurred within the first three weeks after initial surgery (early) and 16/24 presented with a late onset of symptoms of FRI. A strategy of debridement, antibiotics, and implant retention (DAIR) was successful in 9/24 patients with FRI after pelvic fracture. A total of 10 patients required an exchange of osteo-synthetic implants, whereof three were exchanged to an external fixator. In five patients, we removed the implant because the fracture had already consolidated at the time of revision for infection. A total of 17/24 patients had a poly-microbial infection after a pelvic fracture and 3/24 patients died from post-traumatic multi-organ failure within the first 6 months after trauma. There were no cases of persistent infection within the remaining 21 patients. Although poly-microbial infection is common in FRI after pelvic fracture, the recurrence rate of infection is relatively low. A complex pelvic trauma with significant soft tissue injury is a risk factor for recurrent infection and multiple revisions. A strategy of DAIR can be successful in patients with a stable implant. In cases with recurrent infection or an unstable fracture site, the exchange of implants should be considered.

Myasthenia gravis and independent risk factors for recurrent infection: a retrospective cohort study

BackgroundApproximately 10% to 20% of myasthenia gravis (MG) patients have experienced a myasthenic crisis (MC), which contributes to morbidity and mortality. MC triggered by infection is associated with poor outcomes. However, there is a lack of prognostic factors that clinicians can utilize to target interventions for preventing recurrent infection-triggered MC. This study aimed to characterize clinical manifestations, comorbidities, and biochemical profiles associated with recurrent infection-triggered MC in MG patients.MethodsThis retrospective study included 272 MG patients hospitalized with an infection requiring at least 3 days of antibiotics from January 2001 to December 2019. Patients were further stratified into non-recurrent or recurrent infection groups. Clinical features such as gender, age, concomitant diseases, acetylcholine receptor antibodies and biochemical data (including electrolytes and coagulants), muscle strength of pelvic and shoulder girdle, bulbar and respiratory function, management with an endotracheal tube, Foley catheter, or plasmapheresis, duration of hospitalization, and culture pathogens were recorded.ResultsThe recurrent infection group was significantly older than the non-recurrent group (median age, 58.5 versus 52.0 years). Pneumonia was the most common infection and Klebsiella pneumoniae was the most common pathogen. The presence of concomitant diabetes mellitus, activated partial thromboplastin time prolongation, the duration of hospitalization, and hypomagnesaemia were independently associated with recurrent infection. The presence of deep vein thrombosis, thymic cancer, and electrolyte imbalances i.e., hypokalemia, and hypoalbuminemia were significantly associated with a risk for infection. The influence of endotracheal intubation, anemia, and plasmapheresis during hospitalization were inconsistent.ConclusionsThe independent risk factors for recurrent infections in MG patients identified in this study include the presence of concomitant diabetes mellitus, hypomagnesaemia, activated partial thromboplastin time prolongation, and longer duration of hospitalization, highlighting the need for targeted interventions to prevent recurrent infections in this population. Further research and prospective studies are warranted to validate these findings and refine interventions for optimizing patient care.

Risk factors for recurrent infection in the surgical treatment of infected massive endoprostheses implanted for musculoskeletal tumours

BackgroundInfection is a devastating complication of endoprosthetic replacement (EPR) in orthopaedic oncology. Surgical treatments include debridement and/or one- or two-stage exchange. This study aims to determine the infection-free survival after surgical treatment for first and recurrent EPR infections and identify the risk factors associated with infection recurrence.MethodsThis single-centre cohort study included all patients with primary bone sarcomas or metastatic bone disease treated for infected EPR between 2010 and 2020. Variables included soft tissue status using McPherson classification, tumour type, silver coating, chemotherapy, previous surgery and microorganisms identified. Data for all previous infections were collected.Survival analysis, with time to recurrent infection following surgical treatment, was calculated at 1, 2 and 4 years. Cox regression analysis was used to assess the influence of different variables on recurrent infection.ResultsThe cohort included 99 patients with a median age of 44 years (29–58 IQR) at the time of surgical treatment. The most common diagnoses were osteosarcoma and chondrosarcoma.One hundred and thirty-three surgical treatments for first or subsequent infections were performed. At 2 years of follow-up, overall success rates were as follows: two-stage exchange 55.3%, one-stage exchange 45.5%, DAIR with an exchange of modular components 44.6% and DAIR without exchange of modular components 24.7%.Fifty-one (52%) patients were infection-free at the most recent follow-up. Of the remaining 48 patients, 27 (27%) were on antibiotic suppression and 21 (21%) had undergone amputation.Significant risk factors for recurrent infection were the type of surgical treatment, with debridement alone as the highest risk (HR 4.75: 95%CI 2.43–9.30; P < 0.001); significantly compromised soft tissue status (HR 4.41: 95%CI 2.18–8.92; P = 0.001); and infections due to Enterococcus spp.. (HR 7.31: 95%CI 2.73–19.52); P = 0.01).ConclusionsTwo-stage exchange with complete removal of all components where feasible is associated with the lowest risk of recurrent infection. Poor soft tissues and enterococcal infections are associated with higher risks of recurrent infection. Treatment demands an appropriate multidisciplinary approach. Patients should be counselled appropriately about the risk of recurrent infection before embarking on complex treatment.

Risk Factors of Recurrent Infection in Patients with Staphylococcus aureus Bacteremia: a Competing Risk Analysis.

Although several clinical variables have been reported as risk factors for recurrence of Staphylococcus aureus infection, most studies have not considered competing risk events that may overestimate the risk. In this study, we performed competing risk analysis to identify risk factors related to 90-day recurrence in patients with S. aureus bacteremia (SAB) using a large cohort data from a single tertiary hospital in South Korea. All adults who experienced SAB during admission were prospectively enrolled from August 2008 to December 2019. After the day of the first positive blood culture, recurrence and all-cause mortality were assessed for 90 days. Recurrence was defined as a development of symptoms or signs of infection with or without repeated bacteremia after >7 days of negative blood culture and clinically apparent improvement. Subdistribution hazard ratios (sHR) for recurrence and all-cause mortality were estimated using Fine and Gray models. Of 1,725 SAB patients, including 885 cases (51.3%) of methicillin-resistant S. aureus (MRSA) bacteremia, 85 (5.0%) experienced recurrence during the study period. In a multivariate Fine and Gray regression model, the presence of a vascular graft (subdistribution HR [sHR], 3.48; 95% confidence interval [CI], 1.90-6.40), nasal MRSA carriage (sHR, 2.10; 95% CI, 1.28-3.44), methicillin resistance (sHR, 1.69; 95% CI, 1.00-2.84), and rifampicin resistance (sHR, 2.20; 95% CI, 1.12-4.33) were significantly associated with 90-day recurrence. In a large cohort of SAB patients with a high prevalence of MRSA, indwelling vascular graft, nasal MRSA carriage, methicillin resistance, and rifampicin resistance were potential risk factors for recurrence of S. aureus infection.

Factors affecting the occurrence of osseous lesions in septic shoulder arthritis and the recurrence rate after arthroscopic surgery

The purpose of this study was to determine the incidence of osseous lesions and the recurrence rate after arthroscopic surgery in shoulder septic arthritis patients and evaluate the influencing factors. We retrospectively reviewed 44 patients who underwent arthroscopic surgery for septic arthritis of the shoulder between January 2012 and September 2019. The average age of the patients was 65.57 ± 14.2 years, and 56.8% were female patients. The minimum follow-up period was 12 months (average, 32.8 ± 14.2 months; range, 12-72 months). We assessed variables including sex, age, underlying diseases, duration from symptom onset to magnetic resonance imaging (MRI), duration from symptom onset to surgery, radiologic results (radiography and MRI), history of injection therapy, and postoperative infection. The incidence of osseous lesions and the recurrence rate were calculated according to independent variables. In addition, multivariate logistic regression was performed to identify the risk factors for osseous lesions and recurrent infection after adjustment for other variables. Twenty-one patients had an osseous lesion on MRI, and 12 patients had evidence of bone erosion on radiographs. In univariate analyses, significant (P < .05) risk factors for the presence of osseous lesions were female sex, lower C-reactive protein level, and longer duration from symptom onset to MRI. The overall infection recurrence rate was 22.7% (10 of 44 patients). Culture results and the duration from symptom onset to surgery were significant risk factors for recurrent infection (P < .05). As the duration from symptom onset to MRI increased by 1 day, the probability of osseous lesions increased 1.31-fold (95% confidence interval, 1.08- to 1.59-fold; P = .007), and this probability was significantly higher after correction for other risk factors. To reduce the severity of septic shoulder infection, timely diagnosis and treatment are essential. Even if osseous lesions are present, good results can be obtained if meticulous débridement is performed through arthroscopic surgery. However, functional and radiologic long-term follow-up studies are needed in patients with osseous lesions.

54. The Effect of Targeting High-Risk Patients for Antimicrobial Stewardship Intervention on Hospital-Onset Clostridioides Difficile Infection Rates

Background Clostridioides difficile infection contributes to significant burden on patients and the healthcare system, costing billions in excess costs every year for hospital care. Continued use of antibiotics after C. difficile infection diagnosis is a risk factor for recurrent infection. Also, individuals who have had a recurrence of C. difficile infection are at a higher risk of subsequent episodes. MethodsThis prospective, observational, pre-post study evaluated the effect of implementing a targeted antimicrobial stewardship initiative towards a high-risk target population on the rate of in-hospital C. difficile infection rates. High-risk targets were identified through an electronic health system report of admitted patients at a large academic medical center who were toxin assay positive or had a documented history of C. difficile infection. Subjects who met the criteria were assessed for interventions by the pharmacy-driven antimicrobial stewardship service. The primary outcome compared the hospital-onset C. difficile rates and standardized infection ratio (SIR) before and after implementation of the initiative. The SIR is reported to the National Healthcare Safety Network (NHSN) and is calculated as a ratio between the number of observed and predicted infections, which is adjusted for facility-specific factors that contribute C. difficile risk. Negative binomial regression was used to calculate the predicted C. difficile infections in the SIR. Poisson regression was used to generate a 95% prediction interval for the predicted C. difficile infection rate. ResultsThe mean age of subjects was 63 years old and 85% had no history of prior C. difficile infection. The most common intervention was de-escalation of antibiotics (46%). The post-implementation SIR was 0.55 and hospital-onset C. difficile rate was 13, both of which were significantly lower than predicted. ConclusionTargeting patients who have a history of or are newly diagnosed with C. difficile infection may decrease hospital-onset C. difficile rates.Disclosures All Authors: No reported disclosures

Multifactorial aetiology of recurrent respiratory tract infections in children

Recurrent respiratory tract infections in children are a common health problem. Exposure to harmful environmental agents and coexistence of chronic diseases affect the severity and rate of infections. Ineffective outpatient treatment is an indication for a more comprehensive diagnostic workup. The aim of the study was to determine the cause of recurrent respiratory tract infections in children. The study group included 130 children aged 3–17 years who were referred for diagnostic investigation to determine the cause of recurrent respiratory tract infections. The eligibility criterion for the study group was the occurrence of 8 or more respiratory tract infections a year in children aged up to 6 years and 5 or more infections a year in children aged 7–17 years. The study group was subdivided into the following age groups: 3–5 years (n = 60), 6–9 years (n = 35), 10–13 years (n = 11) and 14–17 years (n = 24). The presence of potential risk factors for recurrent infection was analysed on the basis of questionnaires. Tests and examinations were also performed in order to exclude allergies, ear, nose and throat disorders and gastroesophageal reflux disease. Selected laboratory values (complete blood count, vitamin D concentration, immunoglobulin levels) were compared with those obtained from 86 healthy children from the control group. The majority of children had risk factors for recurrent respiratory tract infections. Adenoid hypertrophy was diagnosed in 44.6% of children, asthma in 36.9%, vitamin D deficiency in 30.7%, gastroesophageal reflux disease in 16.2% and immunodeficiency in 9.2% of children. Multimorbidity was found in 34.6% of the subjects. In the study group, there were higher vitamin D levels [study group: 25.6 ng/mL (25th percentile = 17; 75th percentile = 33.3), control group: 22.84 ng/mL (25th percentile = 16.3; 75th percentile = 28.7); p &lt; 0.044] and higher leukocyte levels [study group: 7.5 × 103/μL (25th percentile = 5.9; 75th percentile = 9.1), control group: 6.4 × 103/μL (25th percentile = 5.3; 75th percentile = 7.7); p &lt; 0.02]. The results indicate that children with recurrent respiratory tract infections are a heterogeneous group of patients. The youngest children were the largest group (n = 60). In the majority of children, the onset of symptoms was associated with the beginning of nursery/preschool or school attendance. In 1 in 3 children, a combined presence of a few diseases was found which increase susceptibility to recurrent respiratory tract infections.

Effectiveness of Bezlotoxumab for Prevention of Recurrent Clostridioides difficile Infection Among Transplant Recipients.

BackgroundBezlotoxumab significantly reduces the incidence of recurrent Clostridioides difficile infection (CDI); however, limited data are available in solid organ transplant (SOT) and hematopoietic cell transplant (HCT) recipients.MethodsWe conducted a single-center retrospective analysis comparing recurrent CDI in SOT and HCT recipients receiving standard of care alone (oral vancomycin, fidaxomicin, or metronidazole) or bezlotoxumab plus standard of care. The primary outcome was 90-day incidence of recurrent CDI, and secondary outcomes included 90-day hospital readmission, mortality, and incidence of heart failure exacerbation.ResultsOverall, 94 patients received bezlotoxumab plus standard of care (n = 38) or standard of care alone (n = 56). The mean age was 53 years; patients had a median of 3 prior Clostridioides difficile episodes and 4 risk factors for recurrent infection. Most patients were SOT recipients (76%), with median time to index CDI occurring 2.7 years after transplantation. Ninety-day recurrent CDI occurred in 16% (6/38) in the bezlotoxumab cohort compared to 29% (16/56) in the standard of care cohort (P = .13). Multivariable regression revealed that bezlotoxumab was associated with significantly lower odds of 90-day recurrent CDI (odds ratio, 0.28 [95% confidence interval, .08–.91]). There were no differences in secondary outcomes, and no heart failure exacerbations were observed.ConclusionsIn a cohort of primarily SOT recipients, bezlotoxumab was well tolerated and associated with lower odds of recurrent CDI at 90 days. Larger, prospective trials are needed to confirm these findings among SOT and HCT populations.

MO978EFFECT OF MYCOPHENOLIC ACID AND TACROLIMUS ON THE INCIDENCE OF INFECTIOUS COMPLICATIONS AFTER KIDNEY TRANSPLANTATION IN CONTRAST WITH THE INCIDENCE OF ACUTE KIDNEY REJECTION

Abstract Background and Aims Kidney transplantation (KTx) remains the most effective type of kidney replacement therapy. Infectious complications remain a common cause of mortality, especially during the first year after KTx. Goal of effective immunosuppressive treatment (IS) must be balanced between the decreasing incidence of acute rejection by maintaining effective levels of IS and at the same time avoiding the incidence of infectious complications caused by dose-dependent toxicity of IS. Method The aim of our analysis was to identify the risk of fixed daily doses of mycophenolic acid (MPA) and concentration controlled doses of tacrolimus (TAC) in the development of a single, recurrent infection and acute rejection after KTx. Results Our analysis consisted of 100 patients after KTx (66 males, 34 females) with anti-thymocyte globulin as an induction IS. We monitored the incidence of single, recurrent infection in 1st month, from 1st to 6th month and from 6th to 12th month after KTx and the incidence of acute kidney rejection in 1st year after KTx. According to multivariant analysis, Daily dose of MPA &amp;gt; 1080 mg and levels of TAC above recommended levels were not independent risk factors for the incidence of the infection. Daily dose of MPA &amp;gt; 1080 mg was a risk factor for recurrent infection in general (OR 1.2964; P = 0.0277), for recurrent bacterial infection from 1st to 6th month (OR 1.2674; P = 0.0151), recurrent bacterial infection (OR 1.2574; P = 0.0436), single viral infection (OR 1.2640; P = 0.0398) from 6th to 12th month after KTx We did not confirmed levels of TAC, above recommended levels in observed periods, as a risk factor for single or recurrent infection regardless of its etiology. We confirmed, incidence of mycotic infection in 1st month after KTx correlated with average level of TAC (13.4 ± 3.2 ng/ml) (P = 0.0300) and with average MPA daily doses (1200 ± 360 mg/day) (P = 0.0203). Correlation between the average daily doses of MPA (730 ± 380 mg/day) and the incidence of bacterial infection (P = 0.0161) and viral infection (P = 0.0161) from 1st to 6th month after KTx were found. We confirmed correlation between the incidence of bacterial infection and the average daily doses of MPA (630 ± 340 mg/day) from 6th to 12th month after KTx (P = 0.0479). By probit dose regression, we confirmed statistical significance between levels of TAC and the incidence of bacterial, mycotic and multidrug-resistant (MDR) infection, correlation between the daily dose of MPA and the incidence of mycotic infection in 1st month after KTx. We found statistical significance between levels of TAC and MDR infection and daily dose of MPA and the incidence of bacterial, mycotic and MDR infection from 1st to 6th month after KTx and we found statistical significance between the daily dose of MPA and the incidence of MDR infection from 6th to 12th month after KTx. In our study, we did not confirmed statistical significance between levels of TAC, daily dose of MPA and the incidence of acute kidney rejection. By logistic regression, neither levels of TAC below recommended values nor daily dose of MPA &amp;lt; 1080 mg were found as an independent risk factors for the incidence of acute kidney rejection. Conclusion In our analysis, we found dose of MPA &amp;gt; 1080 mg/day as a risk factor for recurrent infection starting in the 1st month after KTx and correlation between the incidence of the infections and daily dose of MPA 1 month after KTx, with significant association between the incidence of infections and daily doses of MPA and levels of TAC, without increased risk of acute kidney rejection. In the centers with fixed dosing of IS, this can lead to lowering the risk of infections by decreasing daily doses of MPA 1 month after KTx without increasing risk of infections.

Clinical characteristics associated with the severity of Clostridium [Clostridioides] difficile infection in a tertiary teaching hospital from Mexico

BackgroundClostridium difficile infection (CDI) is a leading cause of healthcare-associated diarrhea worldwide. In this study, risk factors associated with the development of severe-complicated and recurrent outcomes in CDI patients in different age groups, including the non-elderly, were assessed in a third-level hospital. MethodsCDI cases were detected by clinical data and polymerase-chain-reaction (PCR). Clinical, demographic, epidemiological, and microbiological risk factors for CDI were evaluated. ResultsDuring the study period, 248 out of 805 patients with nosocomial diarrhea were diagnosed with CDI and the majority were severe-complicated cases (87.90%). Female gender (OR 3.19, 95% CI 1.19–8.55, p = 0.02) and lymphoma (OR 3.95, 95% CI 1.03–15.13, p = 0.04) were risk factors for severe-complicated CDI. Mature adulthood (51–60 years) (OR 5.80, 95% CI 1.56–21.62, p = 0.01), previous rifampicin use (OR 7.44, 95% CI 2.10–26.44, p = 0.00), and neoplasm (solid malignant neoplasm or hematological malignancies) (OR 4.12, 95% CI 1.01–16.83, p = 0.04) were risk factors for recurrent infection. Autoimmune disorders (OR 6.62, CI 95% 1.26–34.73, p = 0.02), leukemia (OR 4.97, 95% CI 1.05–23.58, p = 0.04), lymphoma (OR 3.79, 95% CI 1.03–12.07, p = 0.04) and previous colistin treatment (OR 4.97, 95% CI 1.05–23.58, p = 0.04) were risk factors for 30-day mortality. ConclusionNewly identified risk factors for recurrent CDI were rifampicin treatment and age between 51 and 60 years; colistin treatment was identified as a risk factor for 30-day mortality. Previously identified risk factors for severe-complicated CDI were confirmed, but with a major impact on non-elderly patients.

Periprosthetic knee infection reconstruction with a hinged prosthesis: Implant survival and risk factors for treatment failure

BackgroundSevere bone and soft tissue defects are common after failed two-stage exchange arthroplasty for periprosthetic joint infection (PJI). There is a paucity of evidence on the outcomes of using a hinged prosthesis for knee PJI reconstruction during second-stage re-implantation, especially regarding implant survivorship, reinfection risk factors, and functionality after successful reconstruction. MethodsA total of 58 knee PJI patients with Anderson Orthopaedic Research Institute (AORI) type II/III defect and soft tissue insufficiency underwent reconstruction with hinged prosthesis. Enrolled patients adhered to a two-stage exchange arthroplasty protocol and were evaluated for a mean follow up of 65.1 months. Kaplan–Meier analysis was conducted for implant survivorship and infection-free survival. Multivariate analysis was used to determine independent risk factors for recurrent infections. Knee Society Score (KSS) was used to evaluate functional outcomes. ResultsThe survivorship of hinged prosthesis was 86.2% at 2 years and 70.2% at 5 years. Infection-free analysis revealed an estimation of 68.9% at 2 years and 60.6% at 5 years. Of the 58 patients, 13 (22.4%) developed recurrent PJI, three (5.2%) aseptic loosening, and one (1.7%) periprosthetic fracture. Multivariate analysis revealed that obesity (hazard ratio (HR), 3.11), high-virulent pathogen (HR, 3.44), and polymicrobial infection (HR, 3.59) were independent risk factors for reinfection. Patients showed a mean improvement of 32.8 ± 7.7 in Knee Society Clinical Score (KSCS) and 30.8 ± 11.0 in Knee Society Function Score (KSFS) after successful reconstruction (P<0.001). ConclusionsUsing hinged knee prosthesis for PJI reconstruction provided an overall implant survival of 70.2% and an infection-free survival of 60.6% at mid-term follow up. Obesity, virulent pathogens, and polymicrobial infections were independent risk factors for infection recurrence.

Two-Stage Treatment of Periprostetic Infection: Mid-Term Results

Purpose — to evaluate the efficiency of two-stage revision arthroplasty performed according to a standardized protocol by a multidisciplinary surgical team. Materials and Methods. 87 patients with deep periprosthetic hip and knee joint infection (PJI) were included into the prospective study. The patients were admitted to the clinic in the period from January 2012 until December 2014 and underwent two-stage revision procedure. First stage included removal of infected implant and insertion of a cemented spacer, second stage — re-implantation of a prosthesis. Results. Re-implantation of a prosthesis was performed in 89.7% (95% CI 82.8–95.4) of cases. Infection recurrence rate was 13.8% (95% CI 6.9–20.7) and 12.8% (95% CI 6.4–21.8) after the first and the second stage, respectively. Overall efficiency of two-stage procedure was 80,5% (95% CI 71.3–88.5) with a median of 4.7 year follow up. Conclusion. Rate of re-implantation, recurrent infection and newly occurred infection should be taken into consideration for evaluation of treatment efficiency. Application of single criteria for assessment of successful treatment outcomes will allow to compare various studies. Positive microbiological tests during the second stage of procedure are not a risk factor for recurrent infection but can be caused by contamination of specimens.

Bacterial Profile of Middle Ear Fluid with Recurrent Acute Otitis Media Infection Using Culture Independent 16S rDNA Gene Sequencing

Background Recurrent otitis media is one of the common infections of childhood. The causative bacterial pathogen is one of the major risk factors of recurrent infection. With limited availability of Indian data, we performed this study to identify the bacterial pathogens. Materials and Methods Otitis media cases were diagnosed based on clinical criteria. Thirty-six middle ear fluid (MEF) samples were collected by tympanocentesis and cultured for pathogens. Seventy-eight per cent of the cases had three previous episodes of otitis media in the past 6 months; the remaining 22% had four episodes in the preceding 6 months. At the time of sample collection, all patients were on antibiotic coverage. Genomic DNA was extracted from MEF samples using Qiagen DNA mini Kit. The 16s rDNA polymerase chain reaction (PCR) and quantitative multiplex (qmPCR) for Streptococcus pneumoniae was performed on these samples. Streptococcus pneumoniae–positive samples were serotyped using PCRSeqTyping. Results None of the 36 samples showed growth by conventional culture. The 16s rDNA PCR identified bacterial pathogens in 33 samples. Four samples gave mixed reads. The organisms identified were Neisseria spp. other than Neisseria meningitidis (n = 7), N. meningitidis (n = 8), Lactococcus spp. (n = 5), S. pneumoniae (n = 2), Pseudomonas aeruginosa (n = 2), Haemophilus influenzae (n = 1), Salmonella infantis (n = 1), Staphylococcus epidermidis (n = 1), Staphylococcus auricularis (n = 1), and Streptococcus sp. (n = 1). The qmPCR detected the presence of S. pneumoniae in six samples. PCRSeqTyping was able to identify Serotype 19A in two samples positive for S. pneumoniae. Conclusion The study demonstrates the usefulness of 16s rDNA PCR protocol to identify the bacterial pathogens in MEF by a culture-independent method. Neisseria spp. were the predominant species identified followed by Lactococcus spp. and S. pneumoniae. Detection of pneumococci by 16s rDNA PCR correlated well with qmPCR-based detection and PCRSeqTyping.

Characteristics of urinary tract infections in children up to 7 years of age

&amp;lt;p&amp;gt;Urinary tract infection (UTI) is defined as a presence of significant bacteriuria in a properly collected urine sample, followed by various clinical manifestations - from asymptomatic bacteriuria to acute pyelonephritis. It is most common in infancy and particularly in females. There is a higher risk of UTI in children with underlying urological anomalies, voiding dysfunction and constipation. The subsequent long-term complications such as hypertension and chronic renal insufficiency might arise in children with recurrent pyelonephritis due to renal scarring. The early and proper diagnosis of UTI needs to be based on the recognition of clinical signs and symptoms of UTI, microscopic examination of urine sediment, urine culture and radiological findings. The objective of various medical imaging studies, including kidney and bladder ultrasound, voiding cystourethrography and technetium-99m-dimercaptosuccinic acid renal scintigraphy, is to identify urinary tract abnormalities, as well as risk factors for recurrent infections. The UTI that has been diagnosed requires a 7-14-day course of antimicrobial therapy in symptomatic and especially febrile children. In most children, the early diagnosis and treatment of recurrent UTI is of utmost importance. In this way the development of permanent kidney damage, as well as permanent consequences will be prevented.&amp;lt;/p&amp;gt;

Training Load, Immune Status, and Clinical Outcomes in Young Athletes: A Controlled, Prospective, Longitudinal Study.

Introduction: Beside positive effects on athlete's health, competitive sport can be linked with an increased risk of illness and injury. Because of high relative increases in training, additional physical and psychological strains, and an earlier specialization and professionalization, adolescent athletes needs an increased attention. Training can alter the immune system by inducing a temporary immunosuppression, finally developing infection symptoms. Previous studies identified Epstein Barr Virus (EBV) as potential indicator for the immune status. In addition to the identification of triggering risk factors for recurrent infections, the aim was to determine the interaction between training load, stress sense, immunological parameters, and clinical symptoms.Methods: A controlled, prospective, longitudinal study on young athletes (n = 274, mean age: 13.8 ± 1.5 yrs) was conducted between 2010 and 2014. Also 285 controls (students, who did not perform competitive sports, mean age: 14.5 ± 1.9 yrs) were recruited. Athletes were examined 3 times each year to determine the effects of stress factors (training load: training hours per week [Th/w]) on selected outcome parameters (clinical [susceptibility to infection, WURSS-21: 21-item Wisconsin Upper Respiratory Symptom Survey], immunological, psychological end points). As part of each visit, EBV serostatus and EBV-specific IgG tiers were studied longitudinally as potential immune markers.Results: Athletes (A) trained 14.9 ± 5.6 h weekly. Controls (C) showed no lower stress levels compared to athletes (p = 0.387). Twelve percent of athletes reported recurrent infections (C: 8.5%, p = 0.153), the presence of an upper respiratory tract infection (URTI) was achieved in 30.7%. EBV seroprevalence of athletes was 60.3% (C: 56.6%, p = 0.339). Mean EBV-specific IgG titer of athletes was 166 ± 115 U/ml (C: 137 ± 112 U/ml, p = 0.030). With increasing Th/w, higher stress levels were observed (p < 0.001). Analyzes of WURSS-21 data revealed no relationship to training load (p = 0.323). Also, training load had no relation to EBV serostatus (p = 0.057) or the level of EBV-specific IgG titers (p = 0.364).Discussion: Young elite athletes showed no increased sense of stress, no higher prevalence of recurrent infections, and no different EBV-specific serological parameters compared to controls. Also, no direct relationship between training loads, clinical complaints, and EBV-specific immune responses was found. With increasing training loads athletes felt more stressed, but significant associations to EBV-specific serological parameters were absent. In summary, EBV serostatus and EBV-specific IgG titers do not allow risk stratification for impaired health. Further investigations are needed to identify additional risk factors and immune markers, with the aim to avoid inappropriate strains by early detection and following intervention.

Performance of an electronic health record-based phenotype algorithm to identify community associated methicillin-resistant Staphylococcus aureus cases and controls for genetic association studies.

BackgroundCommunity associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is one of the most common causes of skin and soft tissue infections in the United States, and a variety of genetic host factors are suspected to be risk factors for recurrent infection. Based on the CDC definition, we have developed and validated an electronic health record (EHR) based CA-MRSA phenotype algorithm utilizing both structured and unstructured data.MethodsThe algorithm was validated at three eMERGE consortium sites, and positive predictive value, negative predictive value and sensitivity, were calculated. The algorithm was then run and data collected across seven total sites. The resulting data was used in GWAS analysis.ResultsAcross seven sites, the CA-MRSA phenotype algorithm identified a total of 349 cases and 7761 controls among the genotyped European and African American biobank populations. PPV ranged from 68 to 100% for cases and 96 to 100% for controls; sensitivity ranged from 94 to 100% for cases and 75 to 100% for controls. Frequency of cases in the populations varied widely by site. There were no plausible GWAS-significant (p < 5 E −8) findings.ConclusionsDifferences in EHR data representation and screening patterns across sites may have affected identification of cases and controls and accounted for varying frequencies across sites. Future work identifying these patterns is necessary.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-2020-2) contains supplementary material, which is available to authorized users.

The Incidence and Predictors of Infection in Psoriasis and Psoriatic Arthritis: Results from Longitudinal Observational Cohorts.

To investigate the rate, type, characteristics, and predictors of infection in a cohort of patients with psoriatic arthritis (PsA) and a cohort of patients with psoriasis without arthritis (PsC). A cohort of patients with PsA and a cohort of patients with PsC were followed according to a standard protocol and information on the occurrence of infections was recorded. The rate of infection was estimated by fitting an exponential model. A Weibull regression model was fitted to estimate the relative risk of first infection associated with a number of covariates. Risk factors for recurrent infections were investigated using generalized estimating equations. There were 498 and 74 infections reported among 695 and 509 patients with PsA and PsC, respectively, with an incidence rate of 19.6 per 100 person-years in the PsA cohort compared with 12.2 in the PsC cohort. The HR of the time to the first infection in PsA versus PsC was 1.6 (p = 0.002), and higher in patients treated with biologics versus nonbiologics at 1.56 (95% CI 1.22-2.00) in PsA and 1.50 (95% CI 0.64-3.54) in the PsC cohorts. Female sex and treatment with biologics were associated with infection in the PsA cohort, whereas a lower Psoriasis Area and Severity Index score and a higher Functional Comorbidity Index were associated with infection in the PsC cohort. Ultraviolet treatment was protective against infection in both cohorts. No difference in rates of hospitalization was found (p = 0.66). There were no infection-related deaths in either cohort. The incidence rate of infection was higher in the PsA than the PsC cohort and higher among patients treated with biologics. The data confirm the association between infection and biologic treatment in psoriatic disease.

Does Stone Removal Help Patients with Recurrent Urinary Tract Infections?

We evaluated the impact of surgical extraction of nonobstructing asymptomatic stones on recurrent urinary tract infections and identified predictors of patients who may be rendered infection-free. We retrospectively reviewed charts to identify patients with recurrent urinary tract infections who underwent surgical stone extraction and were rendered stone-free. Demographic variables as well as procedure, infectious etiology, stone composition and the systemic inflammatory response syndrome rate were also recorded. Patients were divided into 2 groups. Group 1 had no evidence of recurrent infection following surgery while recurrent infection developed in group 2. Univariate analysis was performed using the Wilcoxon signed rank and Fisher exact tests. Logistic regression was used for multivariate analysis. We identified 120 patients with recurrent urinary tract infections and a nonobstructive renal stone. Surgical management included shock wave lithotripsy in 32% of cases, ureteroscopy in 7% and percutaneous nephrolithotomy in 61%. Of the 120 patients 58 (48%) remained infection-free after surgery while 62 (52%) experienced recurrent infection. Factors associated with a higher risk of recurrent infections included type 2 diabetes mellitus (OR 1.73, p = 0.01), hypertension (OR 2.8, p = 0.007) and black ethnicity (OR 13.7, p = 0.009). Escherichia coli infections were more likely to resolve (OR 0.34, p = 0.01). In contrast, Enterococcus infections were more likely to persist (OR 2.5, p = 0.04). On multiple logistic regression analysis only race, hypertension and E. coli infections were significant predictors of infection clearance. Of patients with recurrent urinary tract infections and asymptomatic renal calculi 50% may be rendered infection-free following stone extraction. Patients with risk factors for recurrent infections after surgery should be counseled that stone extraction might not eradicate the infection.

PD8-05 DOES STONE REMOVAL HELP PATIENTS WITH RECURRENT URINARY TRACT INFECTIONS?

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Kidney & Bladder I1 Apr 2015PD8-05 DOES STONE REMOVAL HELP PATIENTS WITH RECURRENT URINARY TRACT INFECTIONS? Mohamed Omar, Hemant Chaparala, Abdullahi Ahmed, and Manoj Monga Mohamed OmarMohamed Omar More articles by this author , Hemant ChaparalaHemant Chaparala More articles by this author , Abdullahi AhmedAbdullahi Ahmed More articles by this author , and Manoj MongaManoj Monga More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.920AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES To evaluate the impact of surgical extraction of non-obstructing asymptomatic stones on recurrent urinary tract infections, and identify predictors of those patients who may be rendered infection-free. METHODS A retrospective study of patients referred with recurrent urinary tract infections who underwent surgical stone extraction with the aim of eradicating the infection. Baseline demographic variables as well as the type of surgery, type of infection, stone composition, readmission rate, and the incidence rate of SIRS were recorded for each patient. Patients were divided into two groups, 1st group with no evidence of recurrence of infection after stone removal and the 2nd with recurrence. Univariate analysis was performed using Wilcoxon's signed-rank test and Fisher's exact test then a Logistic regression was used to test variables during multivariate analysis. RESULTS 120 patients with recurrent urinary tract infections and a non-obstructive renal stone were identified. Surgical management included extracorporeal shockwave lithotripsy (SWL, 32%), ureteroscopy (URS, 7%) and percutaneous nephrolithotomy (PCNL, 61%). 48% (58/120) remained infection-free after surgery with a mean follow-up of 14±3 months, while 52% (62/120) had a recurrence of infection, at a mean time from surgery of 12±2 months. Factors associated with a higher risk of recurrent infections post-procedure included African American race (OR13.7, p=0.009), males with type 2 diabetes (OR 1.73, p=0.0145), and hypertension (OR 2.8, p=.0073). Patients undergoing PCNL were more likely to be rendered infection-free compared to SWL. Infections consisting solely of E.coli were more likely to resolve post-procedure (OR 0.34, p=.0115). In contrast, Enterococcus infections were more likely to persist (OR 2.5, p=.0405). On multiple logistic regression analysis only age, race, HTN and type of surgery were significant. CONCLUSIONS Half of patients with recurrent urinary tract infections and asymptomatic renal calculi may be rendered stone free with stone extraction. Patients with risk factors for recurrent infections after stone extraction should be counseled that stone extraction may not eradicate their infections. PREVALENCE OF INFECTING ORGANISM Infecting organism Group 1(without recurrence) Group 2 (with recurrence) p-value E. coli 31/58 (53%) 31/62 (50%) 0.7056 E. coli (only) 21/58 (36%) 10/62 (16%) 0.0114 K. pneumonia 12/58 (21%) 12/62 (19%) 0.8551 P. mirabilis 6/58 (10%) 7/62 (11%) 0.8677 Urease producing bacteria 9/58 (33%) 23/62 (37%) 0.6184 P. aeruginosa 6/58 (10%) 11/62 (18%) 0.2455 Lactose fermenting bacteria 45/58 (78%) 43/62 (69%) 0.3069 Citrobacter 5/58 (9%) 1/62 (2%) 0.0676 Enterococcus Fecalis 8/58 (14%) 18/62 (29%) 0.0405 © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e191-e192 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Omar More articles by this author Hemant Chaparala More articles by this author Abdullahi Ahmed More articles by this author Manoj Monga More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...