Risk Factors For Acute Infection Research Articles

Are the preoperative albumin levels and the albumin to fibrinogen ratio the risk factors for acute infection after primary total joint arthroplasty?

Acute infection, such as periprosthetic joint infection and superficial surgical site infection, after primary total joint arthroplasty (TJA) is a serious complication, and its risk factors remain controversial. This study aimed to identify the risk factors for acute infection after primary TJA, especially the serological indicators that reflect preoperative nutritional statuses, such as albumin level and albumin to fibrinogen ratio (AFR). We retrospectively reviewed patients who underwent elective primary hip or knee arthroplasty at our institution from 2009 to 2021. Potential risk factors of acute infection and demographic information were extracted from an electronic health record. Patients who suffered acute infection, such as PJI or SSI, after TJA were considered the study group. Non-infected patients were matched 1:2 with the study group according to sex, age, the involved joint (hip or knee), and year of surgery (control group). The variables of potential risk factors for acute postoperative infection (demographic characteristics, preoperative comorbidities and drug use, operative variables, and laboratory values) were collected and evaluated by regression analysis. Restrictive cubic spline regression analysis was also used to examine the relationship between preoperative serum albumin levels and acute postoperative infection. We matched 162 non-infected patients with 81 patients who suffered from acute postoperative infection. Among the patients who suffered from acute infection within 90 days after TJA, 18 were diagnosed with periprosthetic joint infection and 63 with surgical site infection. Low albumin levels were strongly associated with acute postoperative infection (95% confidence interval, 0.822-0.980; P = 0.015). This risk increased as preoperative albumin levels decreased, with a negative dose-response relationship (P overall = 0.002; P nonlinear = 0.089). However, there was no significant association between the AFR and acute infection after primary TJA (P = 0.100). There is currently insufficient evidence to confirm the relationship between preoperative AFR and acute infection after elective primary TJA, while a lower preoperative albumin level is an independent risk factor for acute infection with a negative dose-response relationship. This suggests that optimal nutritional management may be benefited before elective primary TJA.

A mucosal imprint left by prior Escherichia coli bladder infection sensitizes to recurrent disease.

Recurrent bacterial infections are a significant burden worldwide, and prior history of infection is often a significant risk factor for developing new infections. For urinary tract infection (UTI), a history of two or more episodes is an independent risk factor for acute infection. However, mechanistic knowledge of UTI pathogenesis has come almost exclusively from studies in naive mice. Here we show that, in mice, an initial Escherichia coli UTI, whether chronic or self-limiting, leaves a long-lasting molecular imprint on the bladder tissue that alters the pathophysiology of subsequent infections, affecting host susceptibility and disease outcome. In bladders of previously infected versus non-infected, antibiotic-treated mice, we found (1) an altered transcriptome and defects in cell maturation, (2) a remodelled epithelium that confers resistance to intracellular bacterial colonization, and (3) changes to cyclooxygenase-2-dependent inflammation. Furthermore, in mice with a history of chronic UTI, cyclooxygenase-2-dependent inflammation allowed a variety of clinical E. coli isolates to circumvent intracellular colonization resistance and cause severe recurrent UTI, which could be prevented by cyclooxygenase-2 inhibition or vaccination. This work provides mechanistic insight into how a history of infection can impact the risk for developing recurrent infection and has implications for the development of therapeutics for recurrent UTI.

Less functional variants of TLR-1/-6/-10 genes are associated with age.

BackgroundDetermining the prerequisites for healthy aging is a major task in the modern world characterized by a longer lifespan of the individuals. Besides lifestyle and environmental influences genetic factors are involved as shown by several genome-wide association studies. Older individuals are known to have an impaired immune response, a condition recently termed “inflamm-aging”. We hypothesize that the induction of this condition in the elderly is influenced by the sensitivity of the innate immune system. Therefore, we investigated genetic variants of the Toll-like receptor (TLR) family, one of the major family of innate immune receptors, for association with age in two cohorts of healthy, disease-free subjects.ResultsAccording to sex we found a positive association of loss-of-function variants of TLR-1 and −6 with healthy aging with odds ratios of 1.54 in males for TLR-6 (249 S/S), and 1.41, 1.66, and 1.64 in females for TLR-1 prom., TLR-1 (248 S/S), and TLR-1 (602 S/S), respectively. Thus, the presence of these variants increases the probability of achieving healthy old age and indicates that a reduced TLR activity may be beneficial in the elderly.ConclusionsThis is the first report showing an association of TLR variants with age. While a loss of function of an important immune receptor may be a risk factor for acute infections as has been shown previously, in the setting of healthy ageing it appears to be protective, which may relate to “inflamm-aging”. These first results should be reproduced in larger trials to confirm this hypothesis.

Incidence and Risk Factors for Acute Infection After Proximal Humeral Fractures: A Multicenter Study

Incidence and Risk Factors for Acute Infection After Proximal Humeral Fractures: A Multicenter Study

Where Does MRSA Live?

Source: Rodriguez M, Hogan GH, Burnham CA, et al. Molecular epidemiology of Staphylococcus aureus in households of children with community-associated S aureus skin and soft tissue infections. J Pediatrics. 2014; 164(1): 105– 111; doi: 10.1016/j.jpeds.2013.08.072Investigators from Washington University, St Louis, sought to determine if staphylococcal skin and soft tissue infections (SSTI) in children were acquired endogenously or from household members. Eligible patients (cases) were between 6 months and 20 years of age with a culture-confirmed methicillin-resistant Staphylococcus aureus (MRSA) or methicillin-susceptible S aureus (MSSA) SSTI and were also colonized with S aureus in the anterior nares, axillae, or inguinal folds. Molecular typing was done to compare colonizing and infecting isolates in children with S aureus SSTI and their household contacts.Baseline colonization status was assessed for household contacts and index cases. Only the index cases were assessed for colonization status at 1-, 3-, 6-, and 12-month follow-up visits. PCR testing was performed on isolates from household contacts and on infecting and colonizing isolates of the index case at baseline and on any colonizing isolates at the 4 follow-up visits.In all, 163 cases and 562 household contacts were studied. At baseline, 64% of cases were colonized with MRSA, 28% with MSSA, and 9% with both; 68% were colonized at a body site proximal to the infection site. MRSA was cultured from the SSTI in 81% and MSSA in 19% of the index cases. Of the 562 household contacts, 55% were colonized with S aureus: MRSA in 20%, MSSA in 33%, both in 2%. Contacts colonized with MRSA were significantly more likely to have had a SSTI in the past year compared to those not colonized with MRSA (36% vs 17%).There were 27 distinct strains of S aureus identified from all of the 1,299 S aureus isolates. At baseline, 67% of the infected children had at least 1 colonizing strain that matched the strain cultured from their infected site and in 46% there was concordance with a household contact. Of those index cases whose infecting strain did not match the colonizing strain (32%), 28% had at least 1 household contact with a colonizing strain that matched the infecting strain. Over the 12 months of study, index cases carried up to 6 distinct strain types and during this time, 72% were colonized with at least 1 strain that matched the baseline infecting strains.The authors conclude that one third of the children with SSTI were not colonized with the infecting strain, and among these children only about one quarter had a concordant strain in a household contact. This suggests that S aureus infections are acquired from both within and outside the household.Dr Crandall has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.S aureus infections cause a broad range of clinical manifestations including SSTIs, bacteremia, and bone and joint infections. Historically MRSA was associated with hospital acquisition; however, community-associated MRSA (CA-MRSA) has emerged as a prevalent pathogen.1,2The epidemiology of SSTIs in the pediatric population is not completely understood but colonization with CA-MRSA is an established risk factor for acute infections.3 Strategies to prevent SSTI in children have focused on decolonizing the affected person and/or household with a regimen of intranasal antibiotic therapy in conjunction with antiseptic body washes. Although prophylactic decolonization is effective at decreasing S aureus carriage, it does not reduce the incidence of first-time SSTIs.4 Targeted decolonization of individuals with recurrent SSTIs and/or their household contacts, on the other hand, results in a modest reduction in recurrent SSTIs.5 However, it is unclear if removal of colonizing S aureus strains increases risk for acquisition of more virulent strains. Decolonization is currently only recommended in individuals and households with recurrent SSTI.6Overall, the results of this study indicate that a substantial number of SSTIs in children are caused by a strain of S aureus acquired outside the household. These results highlight the need for further investigation into the transmission of CA-MRSA in order to develop more effective strategies for disease prevention.While we await the unraveling of the mysteries of the ecology of MRSA, consider these measures which may decrease the household transmission: cessation of sharing personal items such as towels and washcloths, lotions, and bar soap, as well as the institution of dilute bleach baths (see AAP Grand Rounds, February 2012;27[2]:197).

Incidence and risk factors for acute infection after proximal humeral fractures: a multicenter study

The rate of acute infection after surgery for proximal humeral fractures is not known. The aims of this study were to report the incidence and to analyze the risk factors for infection after proximal humeral fracture treatment. We report a retrospective multicenter study of 452 proximal humeral fractures. Data were modeled by use of univariate and/or linear regression analyses to determine the odds ratio (OR). A logistic regression analysis was used to check for demographic and other characteristics with the potential to confound a true association between risk factors and infection. The mean age was 62.1 years, and 314 patients were female patients. Of the patients, 18 (4%) had an acute infection. The factors that correlated with infection were length of surgery (OR, 1.009; P = .05), preoperative skin preparation with chlorhexidine gluconate (OR, 0.13; P = .008), and prophylactic antibiotic (OR, 10.73; P = .03). The delay to surgery was close to achieving significance (OR, 1.71; P = .06). This study suggests that washing the shoulder with chlorhexidine gluconate and avoiding the use of first-generation cephalosporin in favor of more effective prophylactic therapy are effective at reducing the risk of infection after treatment for proximal humeral fractures.

Evaluation of hepatitis C surveillance in Poland in 1998.

The aim was to evaluate hepatitis C surveillance in Poland during 1998. Hepatitis C reports were obtained from epidemiology offices. Public health staff were interviewed to collect information on surveillance operations. To estimate the proportion of acute cases among the total reported, a study was conducted in the Warsaw district to validate case reports. A total of 1661 (97.2%) hepatitis C cases were studied. Hepatitis C surveillance was timely and acceptable to the user, but did not provide a number of information elements required to differentiate acute from chronic cases of infection. Of the 268 case reports available in the Warsaw district, only 15 (5.6%) met the acute hepatitis C case definition. It is concluded that hepatitis C surveillance in Poland cannot provide useful incidence estimates and information regarding risk factors for acute infection. A strict case definition and a modified case form with specific questions for HCV transmission routes should be applied.