Risk Factors For Recurrent Infection Research Articles

Risikofaktoren für eine fehlgeschlagene Infektsanierung nach periprothetischer Hüftprothesenspätinfektion

Despite extensive cleansing concepts recurrent infections are relatively common especially for infections of hip prostheses. The aim of this retrospective study was to identify factors which hinder cleansing and facilitate recurrence. This study included 40patients with periprosthetic delayed hip prosthesis infection who had been treated with the aim of infection cleansing between 2006 and 2008. Infection cleansing was carried out using a standardized treatment regimen with two and multiple phase reimplantation of the hip prosthesis following successful pathogen eradication. A clinical course follow-up was carried out after 2years. Of the patients 18 (45%) were free of recurrence following successful eradication and reimplantation of the prosthesis and 5 (12.5%) suffered recurrence of infection after primarily successful revision prosthesis. In 17 patients (42.5%) treatment was switched to an alternative procedure primarily due to an uncleansable infection. In the group of patients with recurrent infections or untreatable infection, resistant pathogens could be detected significantly more often (p=0.001), in particular methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant Staphylococcus epidermidis (MRSE) and highly resistant Pseudomonas. This group had a significantly worse American Society of Anesthesiologists (ASA) score (p = 0.002). The number of surgical interventions in this group was significantly higher. A poorer general physical condition and resistant infectious pathogens are the main risk factors for recurrent infections following prosthesis reimplantation. Therefore, a different treatment concept should be used for polymorbid patients with resistant pathogen infections.

Antibiotic Prophylaxis in Pediatric Urology: An Update

This article discusses the use of antibiotic prophylaxis in the treatment of three common conditions encountered by the pediatric urologist: 1) children with urinary infection and structurally and neurologically normal urinary tracts; 2) children with vesicoureteral reflux (VUR); and 3) children with prenatally diagnosed ureteropelvic and ureterovesical obstruction. The literature remains unclear and contradictory. Additional significant risk factors for recurrent infection are age, circumcision status in boys, and toileting function. The evidence for the use of prophylaxis is best in those with VUR, although not everyone with VUR must be on medication. In the absence of definitive evidence, the clinician must individualize the treatment of each patient and family.

Recurrent urinary tract infections in non-pregnant adult women

AbstractRecurrent urinary tract infections occur in approximately 5% of adult women. It has a significant impact on the affected women's quality of life and on health care costs. It is important to be aware of the physiologically protective factors preventing urinary tract infections. The clinician should also be able to identify relevant risk factors for recurrent infection. Clinical evaluation is relatively straightforward in cases without underlying complicating factors, but urine culture ought to be readily utilised. Treatment should be according to local antibiogram patterns and prophylactic and postcoital preventative strategies can be used according to current evidence. Certain subpopulations such as HIV positive patients require a different approach compared to the general population.

Risk factors for recurrent sexually transmitted infections in Uganda.

To identify predictors of recurrent sexually transmitted infections (STIs). A cross-sectional interview survey. STD Clinic, Old Mulago Hospital, Kampala. Eligible patients answered questions about their socio-demographic situation; STI symptoms; sexual behaviour; sexual partner referral; health seeking behaviour and whether they had a recurrent infection or not. Bivariate and multivariate stepwise logistic regression models were used to identify independent predictors of recurrent STIs. Fifty two (38%) out of 138 patients had recurrent STIs. On bivariate analysis the predictors of recurrent STIs were: being male; age > or = 25 years; inability to read in English; presenting with genital itching; attributing source of symptoms to sexual partner; not being asked to refer sexual partners at previous treatment site; having more than five lifetime partners; knowing how to use a condom; ever using a condom; and using a condom at least once in the previous three months. On multivariate analysis, independent risk factors for recurrent infection were: age > or = 25 years (Adjusted Odds Ratio [AOR] = 2.70, 95% CI 1.20, 5.88); inability to read English AOR = 3.09, (95% CI 1.38, 6.92); and having more than five, lifetime partners AOR = 2.56 (95% CI 1.11, 5.88). Reducing the number of sexual partners and targeting people who do not speak English with health education messages in the local language may reduce the frequency of recurrent STIs.

Recurrent sternal infection following treatment with negative pressure wound therapy and titanium transverse plate fixation☆

To provide a definition for recurrent sternal infection (RSI), analyse the risk factors and describe the management of this complication following treatment of deep sternal wound infection (DSWI) with horizontal titanium sternal osteosynthesis and coverage with pectoralis major myocutaneous flaps. Between 2002 and 2007, 10665 patients were submitted to open-heart surgery (OHS) in our institution, of whom 149 (1.4%) developed a DSWI. Negative pressure wound therapy (NPWT) followed by sternal osteosynthesis with musculocutaneous coverage was used in 92 (61.7%) patients. A retrospective review was done using a prospectively maintained database to identify risk factors for recurrent infection in this group of patients. Of the 92 patients who underwent sternal osteosynthesis, nine (9.8%) developed recurrent sternal infection requiring hardware removal. Univariate analysis showed that preoperative methicillin-resistant Staphylococcus aureus (MRSA) status (33.3% vs 6.1%; p=0.03) and prolonged intubation time in ICU (44.4% vs 14.6%; p<0.05) were significant risk factors. Two-thirds of these patients were also found to be infected with the same germ as the one responsible for their initial DSWI. No death was reported and sternal integrity was preserved in all patients despite plate removal. To lower the rate of RSI in patients treated with transverse sternal ostheosynthesis along with myocutaneous coverage for DSWI, surgeons must consider the MRSA preoperative status as a significant predictor of RSI and/or persistent infection. Chest-wall integrity in patients with RSI can be maintained after hardware removal, even after only a few weeks following initial plating.

In‐vivo efficacy of amodiaquine‐artesunate in children with uncomplicated Plasmodium falciparum malaria in western Kenya

To assess the efficacy of amodiaquine-artesunate in an area with high chloroquine resistance in western Kenya. Twenty-eight day in-vivo efficacy trial of amodiaquine-artesunate in 103 children aged 6-59 months in western Kenya with smear-confirmed uncomplicated Plasmodium falciparum malaria. The 28-day uncorrected adequate clinical and parasitological response (ACPR) was 69.0%, with 15.5% Late Clinical Failure and 15.5% Late Parasitologic Failure rates. The PCR-corrected 28-day ACPR was 90.2%. Clinical risk factors for recurrent infection (recrudescences and reinfections) were lower axillary temperature at enrollment and low weight-for-age Z-score. The presence of single nucleotide polymorphisms pfcrt 76T and pfmdr1 86Y at baseline was associated with increased risk of recurrent infections, both reinfections and recrudescences. Although artemether-lumefantrine (Coartem) is the first line ACT in Kenya, amodiaquine-artesunate is registered as an option for treatment of uncomplicated P. falciparum and remains an effective alternative to Coartem in western Kenya. Continued amodiaquine monotherapy in the private sector may jeopardize the future use of amodiaquine-artesunate as an alternative artemisinin-based combination therapy.

Procalcitonine et prédiction du reflux vésico-urétéral dans l’infection urinaire de l’enfant

An estimated 7% of girls and 2% of boys will have a urinary tract infection before 6 years of age, and between 20 and 40% of these children are diagnosed with vesicoureteral reflux. Reflux is a risk factor for recurrent infections and renal scarring, which can lead to hypertension and kidney failure. Pediatric guidelines recommend routine voiding cystourethrography, but this is a painful and expensive examination that exposes children to radiation. Reliable non invasive markers of reflux would therefore be extremely useful. Ultrasonography and clinical decision rules have poor sensitivity for vesicoureteral reflux. In contrast, the level of procalcitonin, a marker of the severity of bacterial infections, is a good predictor of cystographic findings in children with a first febrile urinary tract infection. Indeed, a procalcitonin level below 0.5 ng/ml predicted the absence of radiological reflux with a sensitivity of more than 75% in the French princeps study. This was validated by a prospective European study, in which sensitivity reached 100% for high-grade reflux. Procalcitonin assay can thus avoid voiding cystourethrography in 40 to 50% of young children with febrile urinary tract infections.

Does UTI Prophylaxis Cause More Harm Than Good?

Urology| September 01 2007 Does UTI Prophylaxis Cause More Harm Than Good? AAP Grand Rounds (2007) 18 (3): 25–26. https://doi.org/10.1542/gr.18-3-25 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Does UTI Prophylaxis Cause More Harm Than Good?. AAP Grand Rounds September 2007; 18 (3): 25–26. https://doi.org/10.1542/gr.18-3-25 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: urinary tract infections, recurrent urinary tract infections, antibiotic prophylaxis Source: Conway PH, Cnaan A, Zaoutis T, et al. Recurrent urinary tract infections in children: Risk factors and association with prophylactic antimicrobials. JAMA. 2007;298:179–186; doi:10.1001/jama.298.2.179 The AAP currently recommends antimicrobial prophylaxis in young children with vesicoureteral reflux to prevent recurrent urinary tract infection (UTI).1 However, few studies have evaluated the risk factors for recurrent infections. In this study from the University of Pennsylvania, data were extracted from electronic health records of 27 diverse primary care pediatric practices in Delaware, New Jersey, and Pennsylvania. Among 74,974 children aged six years with at least two clinic visits between 2001 and 2006, the authors identified 775 with a diagnosis of UTI. After excluding children with prior UTI, observation time <24 days, presence of a chronic medical condition, and patients with UTI diagnosed only by bag urine specimen, 611 children remained for analysis. UTI was defined as a... You do not currently have access to this content.

Functional polymorphisms in the mannan-binding lectin 2 gene: Effect on MBL levels and otitis media

Mannan-binding lectin (MBL) can bind to microorganisms, initiating the lectin pathway of complement activation. Aberrant MBL serum levels, caused by MBL2 gene polymorphisms, are a possible risk factor for recurrent infections. Within the 7 common MBL haplotypes, still considerable variation in MBL serum levels exists. To investigate functional MBL levels and MBL2 polymorphisms in a large cohort of children with recurrent acute otitis media. Twelve genetic variants in the MBL2 gene and functional MBL serum levels were determined in a cohort of children with recurrent acute otitis media. Haplotypes were constructed and associated with functional MBL serum levels and the number of otitis episodes in the previous year. The 7 common MBL2 haplotypes mainly determine the level of functional MBL in serum. In addition, the 3130G>C single nucleotide polymorphism, located in exon 4, further significantly influenced functional MBL levels within the LXPA haplotype. LXPA carriers with 3130G showed a significantly lower geometric mean functional MBL serum level of 0.19 mug/mL compared with 0.70 mug/mL in 3130C carriers (P = .026). Nonwild-type MBL2 carriers between 12 and 24 months had a significantly increased number of otitis episodes (5.1/y) compared with wild-type MBL2 carriers (4.1/y; P = .027). In older children, this association was not found anymore. Additional single nucleotide polymorphisms within the 7 common haplotypes can further explain the observed variation in functional MBL serum levels. MBL seems to be of particular clinical importance during early childhood, when maternally derived antibodies have waned, and protective adaptive immunity is not well developed yet. Single nucleotide polymorphisms in the promoter region, in exon 1, and in exon 4 of MBL2 contribute to increased risk for otitis media in children younger than 2 years.