Significant Risk Factor For Infection Research Articles

Gastric bezoars secondary to mixed infection with Sarcina ventriculi and G + bacilli: a case report

Sarcina ventriculi is a bacterium with a specific histological morphology and infection can present with symptoms such as abdominal pain, nausea, vomiting and occasionally fatal complications. Delayed gastric emptying is regarded as the most significant risk factor for infection. Its pathogenicity is currently unknown and treatment options are inconsistent. Here we report a case of gastric bezoars secondary to a mixed infection of Sarcina ventriculi and G + bacilli, which is diagnosed by a pathological biopsy.

Prevalence, Risk Factors, and Impact of Bacterial or Fungal Infections in Acute Liver Failure Patients from India.

We evaluated the prevalence, risk factors, and impact of bacterial/fungal infections in acute liver failure (ALF) patients. We analyzed clinical, biochemical, and microbiological data of ALF patients with and without bacterial/fungal infections admitted at an institute over the last 5 years. We enrolled 143 patients, 50% males, median age 25years, with acute viral hepatitis (32.2%), drug-induced injury (18.2%), and tropical illness (14%) as aetiologies of ALF. 110 patients (76.9%) developed bacterial/fungal infections [Bacterial infection: MDR: 70%, PDR: 7%, ESBL: 40%, CRE: 30%, CRAB: 26.6%, MDR-EF: 13.3% and fungal infection: 19 (17.3%)]. On univariable analysis, SIRS (33.6% vs.3%), ICU admission (78.2% vs. 45.5%), mechanical ventilation (88.2% vs. 51.5%), inotropes (39.1% vs. 6.1%), invasive catheters (91.8% vs. 39.4%), and prolonged catheterization (6days vs. 0days) were significant risk factors for infections (p < 0.05, each). In contrast, SIRS and catheterization independently predicted infection on multivariable regression. Organ failures [3 (2-4) vs. 1 (0-2)], grade-III-IV HE (67.3% vs. 33.3%), circulatory failure (39.1% vs. 6.1%), coagulopathy (INR > 2.5: 58.2% vs. 33.3%), renal injury (28.2% vs. 6.1%) (p < 0.05), MELD (32.9 ± 8.2 vs. 26.7 ± 8.3) and CPIS [3(2-4) vs. 2(0-2)] were higher in infected vs. non-infected patients (p < 0.001). 30-day survival was significantly lower in infected vs. non-infected patients (17.3% vs. 75.8%, p < 0.001), while no patient survived with fungal infections. Refractory septic shock was the commonest cause of mortality in patients. Infections due to MDR organisms are high, fungal infections are fatal, and refractory septic shock is the dominant reason for mortality, implying bacterial and fungal infections as the major killer in ALF patients.

The Incidence of and Risk Factors for Breast Infections After Tissue Expander Placement

Abstract Goals/Purpose Breast tissue expansion has a reported infection rate ranging from 2.4-25% in the literature when used for post mastectomy breast reconstruction. Expander infections may prolong the reconstructive timeframe, increase costs, portend poorer aesthetic outcomes, and decrease patient satisfaction. Medical treatments are often attempted to salvage implants prior to surgical treatment including irrigation, implant replacement, or explantation. The purposes of this study include 1) to ascertain the incidence of breast infections in patients with breast tissue expanders at our institution, 2) explore the success of medical treatments in precluding explantation, 3) identify modifiable risk factors associated with any post-expander breast infection, and 4) identify modifiable risk factors associated with post-expander breast infections requiring subsequent explantation. Methods/Technique A single-center, single-surgeon, 4-year retrospective review was performed. Patient demographics, medical comorbidities, and surgical techniques were extracted. Clinical infection was defined by clinical evidence of cellulitis or abscess in a breast with a tissue expander present, regardless of the presence or absence of systemic symptoms. Preservation of the tissue expander following treatment of clinical infection with either antibiotics or surgical intervention was considered salvage, whereas removal of the expander with pocket closure was considered explantation. The incidence of infection and explantation were calculated separately. Chi-squared analysis was used to identify risk factors for both infection and explantation separately. A generalized estimated equations model was used to account for patients who had one infected breast and how that might affect the risk of infection in the other breast or in either breast following future implant or expander placement. It was also used to identify odds ratios for infection and explantation related to the risk factors identified previously. Results/Complications A total of 349 breasts with tissue expanders in 163 patients were included in the study cohort. There was a 17.1% incidence of infection in the cohort and a 12.9% incidence of explantation secondary to infection. Of the infected breasts, 24.6% were managed with antibiotics alone. Significant risk factors for infection were prior chest radiation (p=0.021; OR 3.73, CI95% 1.22-11.34) and use of immune modulating drugs (p=0.012; 2.81, CI95% 1.25-6.30). Significant risk factors for explantation were age (p=0.030), tissue expander volume (p=0.038), and subpectoral placement (p=0.012). For each 5-year increase in age, odds ratio for explantation was 1.44 (CI95% 1.04-2.01). For every 50-cc increase in tissue expander volume, odds ratio for explantation was 1.28 (CI95% 1.02–1.55). Subpectoral placement carried an odds ratio of 11.5 (CI95% 1.7-77.3) compared to prepectoral placement or placement of a tissue expander under autologous tissue transfer (latissimus or free tissue transfer). Conclusion The incidence of breast tissue expander related infections at our institution was within the ranges previously published. A quarter of the breasts with infections were able to successfully avoid explantation with prompt initiation of antibiotic therapy. A history of chest radiation prior to mastectomy and the use of immune modulating drugs were noted to be significant risk factors for developing infections in breasts with tissue expanders. Explantation was more common with increases in age and tissue expander volumes. Surprisingly, subpectoral placement portended a significantly higher risk of explantation as compared to prepectoral tissue expander placement or when placed under a flap. BMI, a history of smoking, intent of mastectomy (prophylactic vs curative), adjuvant radiation, and use of acellular dermal matrix were not significantly related to either infection or explantation in this cohort.

New perspectives for fascioliasis in Upper Egypt's new endemic region: Sociodemographic characteristics and phylogenetic analysis of Fasciola in humans, animals, and lymnaeid vectors.

Fascioliasis is a significant vector-borne disease that has emerged in numerous tropical and subtropical countries causing severe health problems. Egypt is one of the fascioliasis endemic regions; however, the current situation in Upper Egypt is understudied, with only sporadic human cases or outbreaks. This study aims to highlight the sociodemographic characteristics of human fascioliasis in a newly emerged endemic area in Upper Egypt, along with risk factors analysis and the molecular characteristics of the fasciolid population in humans, animals, and lymnaeid snails. The study reported Fasciola infection in patients and their close relatives by analyzing the risk of human infection. Morphological and molecular characterization was performed on lymnaeid snails. Multigene sequencing was also used to characterize fasciolids from human cases, cattle, and pooled snail samples. The study identified asymptomatic Fasciola infection among family members and identified the presence of peridomestic animals as a significant risk factor for infection. This is the first genetic evidence that Radix auricularia exists as the snail intermediate host in Egypt. This study revealed that Assiut Governorate in Upper Egypt is a high-risk area for human fascioliasis that requires additional control measures. Fasciola hepatica was the main causative agent infecting humans and snail vectors in this newly emerged endemic area. In addition, this is the first report of R. auricularia as the snail intermediate host transmitting fascioliasis in Upper Egypt. Further research is required to clarify the widespread distribution of Fasciola in Egypt's various animal hosts. This provides insight into the mode of transmission, epidemiological criteria, and genetic diversity of fasciolid populations in Upper Egypt.\.

Early cytopenias and infections after standard of care idecabtagene vicleucel in relapsed or refractory multiple myeloma

AbstractIdecabtagene vicleucel (ide-cel) was FDA-approved in March 2021 for the treatment of relapsed/refractory multiple myeloma after 4 lines of therapy. On the KarMMa trial, grade ≥ 3 cytopenias and infections were common. We sought to characterize cytopenias and infections within 100 days after ide-cel in the standard-of-care (SOC) setting. This multi-center retrospective study included 52 patients who received SOC ide-cel; 47 reached day-90 follow-up. Data were censored at day 100. Grade ≥ 3 cytopenia was present among 65% of patients at day 30 and 40% of patients at day 90. Granulocyte colony stimulating factor (G-CSF) was administered to 88%, packed red blood cell transfusions to 63%, platelet transfusions to 42%, thrombopoietin (TPO) agonists to 21%, intravenous immunoglobulin to 13%, and CD34+ stem cell boosts to 8%. At day 100, 19% and 13% of patients had ongoing use of TPO agonists and G-CSF, respectively. Infections occurred in 54% of patients and were grade ≥ 3 in 23%. Earlier infections in the first 30 days were typically bacterial (68%) and severe (50%). Later infections between days 31 and 100 were 50% bacterial and 42% viral; only 13% were grade ≥ 3. On univariate analysis, high pre-CAR-T marrow myeloma burden (≥ 50%), circulating plasma cells at pre-lymphodepletion (LD), and grade ≥ 3 anemia at pre-LD were associated with grade ≥ 3 cytopenia at both days 30 and 90. Longer time from last bridging treatment to LD was the only significant risk factor for infection.

Clinical Manifestation of Infectious Keratitis in Ocular Graft Versus Host Disease

Purpose: We evaluated the clinical manifestations of, and risk factors for, infectious keratitis in patients with ocular graft-versus-host disease (GVHD).Methods: A total of 11 patients who developed infectious keratitis after a diagnosis of ocular GVHD between January 2015 and December 2020, and 36 who did not (the control group), were included in this retrospective study. We recorded sex, age, any underlying disease, any other organ affected by systemic GVHD, systemic immunosuppressant use, follow-up duration, clinical manifestations, the severity of ocular GVHD prior to infection, the size of the epithelial defect, the depth of infiltration, hypopyon status, and the results of microbiological tests. Systemic and ocular indices (including systemic GVHD status) were compared using the chi-squared test. Risk factors for infection were identified.Results: Of the corneal indices, the presence of corneal filaments, the extent of corneal neovascularization, and the number of corneal epithelial defects were significantly higher in the infected group (p = 0.023, p = 0.004, and p = 0.001, respectively). GVHD severity was also significantly higher in that group (p &lt; 0.001). The presence of corneal filaments, corneal neovascularization, and corneal epithelial defects prior to infection correlated significantly with the risk of infection (p = 0.046, p = 0.010, and p = 0.003, respectively). Multivariate analysis identified corneal epithelial defects as a significant risk factor for infection (p = 0.029).Conclusions: In patients with ocular GVHD, corneal epithelial defects, corneal neovascularization, and corneal filaments prior to infection were associated with the development of infection. In particular, corneal epithelial defects before infection was a significant risk factor for infection.

Prevalence and risk factors of urogenital schistosomiasis among under-fives in Mtama District in the Lindi region of Tanzania.

IntroductionDespite the ongoing intervention for schistosomiasis control among school-age children in the Lindi region of Tanzania, urogenital schistosomiasis continues to be a public health problem, presumably because other at-risk populations are not covered in praziquantel deworming campaigns. Evidence shows that under-fives become infected in their early life hence the need to understand the disease profile and the risk factors for exposure to infection so as to plan effective control strategies in this group. This study examined the prevalence and risk factors of urogenital schistosomiasis among under-fives in the Mtama district, Lindi region of Tanzania.Methodology/Principal findingsA quantitative community-based cross-sectional study was carried out among 770 participants (385 under-fives and their 385 parents/guardians) in the Mtama district to investigate the burden and the risk factors associated with S. haematobium infection. A single urine specimen was collected from the under-fives and tested for macro and microhaematuria, presence of S. haematobium ova, and intensity of infection. A structured questionnaire gathered on risk factors for S. haematobium exposure in under-fives from their parents/guardians. Data analysis was performed using descriptive statistics, chi-square test, and logistic regression.Prevalence of S. haematobium ova was 16.9%, and that of macro and microhaematuria was 6% and 17.9%, respectively. Of the 65 positive under-fives, 49 (75.4%) 95% CI 65.4–86.3 had a light infection intensity, and 16 (24.6%) 95% CI 13.7–35.5 had a heavy infection intensity. Among the assessed risk factors, the parents/guardians habit of visiting water bodies for domestic routines (AOR: 1.44, 95% CI: 1.13–1.74), especially the river (AOR: 6.00, 95% CI: 1.20–35.12), was found to be a significant risk factor for infection of S. haematobium in under-fives.Conclusion/SignificanceA moderate prevalence of S. haematobium was found among the under-fives conceivably with adverse health events. The infected under-fives could be a source of continuity for transmission in the community. An intervention that covers this group is necessary and should be complemented with regular screening, health education campaigns, and an adequate supply of safe water.

Risk Stratification of SARS-CoV-2 Breakthrough Infections Based on an Outbreak at a Student Festive Event.

In early 2022, the Coronavirus disease 2019 (COVID-19) remains a global challenge. COVID-19 is caused by an increasing number of variants of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Here, we report an outbreak of SARS-CoV-2 breakthrough infections related to a student festive event with 100 mostly vaccinated guests, which took place in Northern Bavaria, Germany, in October 2021. The data were obtained by retrospective guest interviews. In total, 95 students participated in the study, with 94 being fully vaccinated and 24 reporting infection by the delta variant. Correlation analyses among 15 examined variables revealed that time spent at the event, conversation with the supposed index person, and a homologous viral vector vaccination regime were significant risk factors for infection. Non-significant observations related to higher rates of infection included time since last vaccination, shared use of drinking vessels, and number of individual person-to-person contacts at the event. Our data suggest that a high rate of breakthrough infections with the delta variant occurs if no preventive measures are practiced. To limit infection risk, high-quality testing of participants should be considered a mandatory measure at gatherings, irrespective of the participants’ vaccination status.

Complications After Implantation of Subcutaneous Central Venous Ports: Focus on Infection and Catheter Pinch-off

Objective The objective of this study was to determine the causes of postoperative complications associated with subcutaneous central venous ports. Summary of Background Data Central venous ports were subcutaneously implanted in 523 patients between January 2005 and December 2013. Methods The purpose of port implantation was administration of chemotherapy in 439 patients and home central venous nutrition in 84 patients. The underlying disease was malignant in 481 patients and benign in 42. Results The median follow-up was 12 months (range, 1–99 months), and postoperative complications developed in 69 patients (13%). Infection occurred in 40 patients (7.6%) and catheter pinch-off in 11 patients (3%). Significant risk factors for infection were nutritional port placement (P &amp;lt; 0.001) and use of a femoral vein approach (P = 0.001). A left subclavian approach was a significant risk factor for catheter pinch-off (P = 0.003). Conclusions Postoperative complications, mainly infections and catheter pinch-off, developed in 13% of the patients. As for measures against complications, a femoral vein approach should be avoided to prevent infection. Moreover, because ports for parenteral nutrition require multiple punctures, methods to reduce the number of punctures and techniques for disinfection and management should be reevaluated. To prevent catheter pinch-off, an internal jugular vein approach should be used instead of a left subclavian approach.

Detection, Molecular Identification and Transmission of the Intestinal Protozoa Blastocystis sp. in Guinea from a Large-Scale Epidemiological Study Conducted in the Conakry Area.

Blastocystis sp. is a single-celled parasite estimated to colonize the digestive tract of 1 to 2 billion people worldwide. Although it represents the most frequent intestinal protozoa in human stools, it remains still under-investigated in countries with a high risk of infection due to poor sanitary and hygiene conditions, such as in Africa. Therefore, the present study was carried out to determine the prevalence and subtype (ST) distribution of Blastocystis sp. in the Guinean population. For this purpose, fecal samples were collected from 500 individuals presenting or not digestive disorders in two hospitals of Conakry. Search for the parasite in stools was performed by real-time PCR targeting the small subunit rDNA gene followed by sequencing of the PCR products for subtyping of the isolates. A total of 390 participants (78.0%) was positive for Blastocystis sp. Five STs were identified in the Guinean cohort (ST1, ST2, ST3, ST4 and ST14) with varying frequency, ST3 being predominant. Among them, ST4 was found in only two patients confirming its global rarity in Africa whereas infections by ST14 were likely the result of zoonotic transmission from bovid. No significant association was detected between Blastocystis sp. colonization or ST distribution and the symptomatic status of Guinean subjects or the presence of digestive symptoms. In contrast, drilling water consumption represented a significant risk factor for infection by Blastocystis sp. Predominance of ST3 coupled with its low intra-ST diversity strongly suggested large-scale human-to-human transmission of this ST within this cohort. In parallel, the highest intra-ST diversity of ST1 and ST2 was likely correlated with various potential sources of infection in addition to anthroponotic transmission. These findings highlighted the active circulation of the parasite in Guinea as reported in some low-income African countries and the necessity to implement prevention and control measures in order to limit the circulation of this parasite in this endemic geographical area.

Curvularia Sinusitis in Leukemic Patients

Abstract Curvularia species are dematiaceous filamentous fungi that can cause a variety of infections in both immunocompetent and immunocompromised hosts. We present 2 cases of severely immunosuppressed patients with acute invasive fungal sinusitis due to Curvularia species. Both patients had a history of hematologic malignancy with refractory disease and prolonged neutropenia. They presented with facial and sinus pain, which prompted maxillofacial computed tomography that showed acute sinusitis. Subsequently, they underwent nasal endoscopy with a biopsy that revealed a definitive diagnosis of invasive fungal sinusitis. Dematiaceous fungi are responsible for most fungal sinusitis cases, with Curvularia being one of the most common species isolated. Generally, invasive fungal rhinosinusitis may follow a relatively innocuous and nonspecific course. In addition, fungal infections may complicate chronic allergic sinusitis. Computed tomography scan is the first imaging modality of choice, and magnetic resonance imaging has a role in prognostication in acute invasive fungal rhinosinusitis. Endoscopic sinus surgery with biopsy yields a definitive diagnosis and is therapeutic. Management typically includes a combination of surgery and antifungal agents. Severe neutropenia is a significant risk factor for infection and is associated with poor outcomes. Aggressive surgical debridement, combined with antifungal therapy, should be emphasized in leukemic patients despite their prolonged neutropenia and bleeding tendency.

Infections in systemic lupus erythematosus: A study of incidence and risk factors in 100 patients from western India

Aim: The present study was conducted to evaluate the incidence and characteristics of infections in patients of systemic lupus erythematosus (SLE) and determine the risk factors for infection.Materials and Methods: This is a prospective, observational study carried out at a single-center, tertiary care hospital. The study included all adult SLE patients diagnosed as per the revised American College of Rheumatology (ACR) criteria from January 2015 to October 2019. Episodes of infection and pathogens isolated were recorded.Results: A total of 100 patients with SLE were evaluated (94 females and 6 males). Forty-seven (47%) patients suffered from 54 episodes of infection. Urinary tract infections were most common (31.48%), followed by skin and mucous membrane (27.78%). Escherichia coli (E. coli) was the most common organism isolated in 9 (16.8%) cases. Tuberculosis was seen in 6 (11.1%) patients. Forty-three (79.6%) patients had a SLE disease activity index score of more than 5 at the time of infection. Significant risk factors for infection included use of prednisolone, prednisolone dose higher than 10 mg, use of cyclophosphamide within the preceding 3 months of infections, use of other immunosuppressive agents, and leukopenia. Renal lupus and presence of comorbidities did not have a significant association with occurrence of infections. The relative risk of infections in SLE patients was 4.7 compared to non SLE controls.Conclusion: Patients of SLE are at increased risk for various infections. Management of SLE needs vigilance for infection and judicious use of immunosuppressive drugs.

Impact of Chronic Obstructive Pulmonary Disease on Infectious Complications and Mortality in Patients With Aneurysmal Subarachnoid Hemorrhage.

Background and Purpose: Chronic obstructive pulmonary disease (COPD) has been associated with several complications and mortality in acutely ill patients. For patients with aneurysmal subarachnoid hemorrhage (aSAH), the association between COPD and clinical outcomes remains unclear.Methods: In this retrospective cohort study, we analyzed consecutive aSAH patients admitted to the West China Hospital between 2014 and 2019. Propensity score matching analysis and cox regression models was used to assess the association between COPD and mortality. The primary outcome was long-term mortality.Results: Using a clinical database from a large university medical center, 2,925 patients with aSAH were identified, of whom 219 (7.5%) also had COPD. Patients were followed-up for a median of 3.8 years, and during follow-up 633 patients (21.6%) died. Long-term mortality was higher in patients with COPD compared to patients without COPD in the Cox regression models [adjusted hazard ratio (HR) 1.52, 95% confidence interval (CI) 1.14–2.02]. Propensity score matching analysis also showed similar associations between COPD and mortality in hospital, at 1 year, at 2 years, and at long-term. Similarly, patients with COPD had significantly higher incidence of infections, such as pneumonia [odds ratio (OR) 3.24, 95% CI 2.30–4.56], urinary tract infection (OR 1.81, 95% CI 1.20–2.73), bloodstream infection (OR 3.83, 95% CI 1.84–7.99), and hospital infection (OR 3.24, 95% CI 2.28–4.61).Conclusions: Among aSAH patients, COPD is associated with increased mortality. COPD represents a significant risk factor for infections. Given that these are preventable complications, our findings are of clinical relevance.

Assessment of awareness of workers of the forensic medical service of the Republic of Tatarstan (bureau) about tuberculosis infection

Introduction. Forensic workers are at high risk of contracting Koch's bacillus infection. Significant risk factors for infections are a high microbial load, increased traumatism, and the absence of lifetime medical records of tuberculosis in cadavers admitted for examination. In addition, sporadic cases of infection continue to be reported, necessitating measures to improve the prevention of personnel infection. In view of the above, there is a great need for research into the awareness of bureau personnel, on the basis of which preventive measures will be developed. Purpose of the study — to examine the awareness of bureau personnel about the main issues of tuberculosis infection, its prevention, ways of infection, diagnosis, and clinical manifestations. Materials and methods. The main method of research was an anonymous questionnaire survey of 262 employees of the Kazan bureau of the Republic of Tatarstan. The obtained data were counted on the service onlinetestpad, where the questionnaire was posted. Results. According to the results of the study, 12 employees (4.6%) out of those interviewed in the bureau had tuberculosis. Forty-three employees (16.4%) reported contact with a sick person at their place of work (training). A total of 147 respondents (56.1%) think that it is possible to get infected by a sick person; 39 respondents (14.9%) think that it is possible to get infected while doing professional duties. Some respondents did not consider important aspects in preventing the formation and spread of TB: a significant part of workers (96 workers, 36.6%) wash dirty work clothes at home by themselves and about the same number of respondents (95 workers, 36.3%) do not consider it important to change work clothes when moving from a "dirty" zone to a "clean" one and vice versa. Discussion. Positive results of the questionnaire were associated with a high degree of competence of the staff, dissemination of TB guidelines, training, and supervision by supervisory authorities. Conclusion. Based on the results, it was found that staff at the Bureau of Forensic Medicine are sufficiently informed about methods of specific and non-specific prevention of tuberculosis and have information about the modes of transmission. However, there is a lack of awareness among certain staff members on how to prevent the spread of tuberculosis infection.

Subgaleal drains may be associated with decreased infection following autologous cranioplasty: a retrospective analysis

Background Autologous bone is often the first choice in cranioplasty following a decompressive craniectomy. However, infection is a common complication, with reported rates up to 25%. While the incidence and management of infection are well documented, the risk factors associated with infection remain less clear. The current study aims to identify predictors of infection risk following autologous cranioplasty. Methods A retrospective analysis was conducted on patients who underwent decompressive craniectomy and cranioplasty using cryopreserved autologous bone flaps between 2010 and 2020. Patient demographics and factors related to both surgeries and infection rates were recorded from patient records. Logistic regressions were conducted to determine which factors were implicated in the development of infection. Results In our cohort, 126 patients underwent autologous cranioplasty. A total of 10 patients (7.9%) developed an infection following reconstruction, with half resulting in implant failure. We did not identify any significant risk factors for infection. Regression analysis identified placement of subgaleal drain following cranioplasty as a protective factor against the development of infection (OR: 0.16, p = 0.007). On average, drains remained in for 3 days, with no difference between the length of drains for those with infection vs. those without (p = 0.757). Conclusions The current study demonstrates an infection rate of 7.9% in patients who receive an autologous cranioplasty following decompressive craniectomy, which is consistent with previous data. Half (4%) of patients who experienced an infection ultimately required removal of the implant. While it is common practice for neurosurgeons to use drains to prevent hematomas and fluid collections, we found that subgaleal drain placement following cranioplasty was associated with decreased infection, thus demonstrating another benefit of a commonly used tool.

Efficacy of a Single Dose of Peri-Operative Antibiotics in Breast Implant Surgery and Risk Factors for Infection in Post-Mastectomy Patients Undergoing Placement of Permanent Breast Implants.

Background: Breast implant placement is a common operation performed by plastic surgeons, with more than 78,664 implant-based breast reconstructions carried out in the United States in 2016. Infection is a major concern for the reconstructive surgeon, with rates estimated at 2%-4% for implant exchanges. Use of peri-operative antibiotics is variable and provider dependent and is not without risk. Methods: Charts for all women undergoing mastectomy and immediate reconstruction at our institution from July 1, 2011-January 1, 2020 by a single plastic surgeon were reviewed. Patient characteristics, operative technique, and history of radiation, chemotherapy, hormonal treatment, and antibiotic protocols were collected for each patient. The data were analyzed using χ2 and Student t-tests. Results: Chart review was performed for 234 consecutive patients undergoing exchange of breast implants. Patients received only a single dose of peri-operative antibiotics before the first incision without post-operative antibiotics. In these patients, a total of 407 implant exchanges occurred. Post-operative cellulitis was found in 13 instances in 12 patients (infection rate of 3.1%) and was treated successfully with oral antibiotics in 11 of 13 cases. Two patients required operative washout (0.04%). Most of the infections (69%) were found on the side of the cancer. Patients experiencing post-operative infections were more likely to have had adjuvant chemotherapy (p = 0.007) than patients without infection. There was no significant difference between the two groups with regard to neo-adjuvant chemotherapy, radiation to the affected breast, or hormonal therapy or in terms of age, Body Mass Index, or the presence of diabetes mellitus. Intra-operative povidone-iodine (Betadine) swabbing and antibiotic selection did not have an impact on infection risk. Conclusions: A single dose of antibiotics results in sufficiently low rates of infection in patients undergoing breast implant exchange. Adjuvant chemotherapy is a clinically significant risk factor for infection in these patients.

Estimating vaccination threshold and impact in the 2017–2019 hepatitis A virus outbreak among persons experiencing homelessness or who use drugs in Louisville, Kentucky, United States

BackgroundBetween September 2017 and June 2019, an outbreak of hepatitis A virus (HAV) occurred in Louisville, Kentucky, resulting in 501 cases and 6 deaths, predominantly among persons who experience homelessness or who use drugs (PEH/PWUD). The critical vaccination threshold (Vc) required to achieve herd immunity in this population is unknown. We investigated Vc and vaccination impact using epidemic modeling. MethodsTo determine which population subgroups had high infection risks, we employed a technique based on comparing the proportion of cases arising before and after the epidemic peak, across subgroups. We also developed a dynamic deterministic model of HAV transmission among PEH/PWUD to estimate the basic reproduction number (R0), herd immunity threshold, Vc and the effect of timing of the vaccination intervention on epidemic and economic outcomes. ResultsOf the 501 confirmed or probable cases, 385 (76.8%) were among PEH/PWUD. Among PEH/PWUD and within the general population, homelessness was a significant risk factor for infection in the initial stages of the outbreak (odds ratios for homeless versus not homeless: 2.62; 95% confidence interval (CI): 1.62–4.25 for PEH/PWUD and 2.39; 95% CI: 1.51–3.78 for all detected cases). Our estimate for R0 ranges between 2.85 and 3.54, corresponding to an estimate of 69% (95% CI: 65–72) for herd immunity threshold and 76% (95% CI: 72%-80%) for Vc, assuming a vaccine with 90% efficacy. The observed vaccination program was estimated to have averted 30 hospitalizations (95% CI: 19–43), associated with over US$490 000 (95% CI: $310 000–700 000) in hospitalization cost. Greater impact was observed with earlier and faster vaccination implementation. ConclusionsVaccination coverage of at least 77% is likely required to prevent outbreaks of HAV among PEH/PWUD in Louisville, assuming a 90% vaccine efficacy. Proactive hepatitis A vaccination programs among PEH/PWUD will maximize health and economic benefits of these programs and reduce the likelihood of another outbreak.

The Impact of Corticosteroid Injection Timing on Infection Rates Following Spine Surgery: A Systematic Review and Meta-Analysis.

Study Design/Setting:Systematic review/meta-analysis.Objectives:The objective of this review was to assess how the risk of infection following lumbar spine surgery varies as a function of the timing of preoperative corticosteroid spinal injections (CSIs).Methods:A systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. PubMed and EMBASE databases were searched and data was pooled for meta-analysis.Results:Six studies were identified for inclusion. Two (33.3%) demonstrated a significant relationship between the timing of preoperative CSIs and the risk of postoperative infection, while 4 (66.7%) demonstrated no impact. A total of 2.5% (110/4,448) of patients who underwent CSI <1 month before surgery experienced a postoperative infection, as compared to 1.2% (1,466/120, 943) of controls, which was statistically significant (RR = 1.986 95% CI 1.202-3.282 P = 0.007). A total of 1.6% (25/1,600) of patients who underwent CSI 0-3 months before surgery experienced a postoperative infection, as compared to 1.6% (201/12, 845) of controls (RR = 0.887 95% CI 0.586-1.341, P = 0.569). A total of 1.1% (199/17 870) of patients who underwent CSI 3-6 months before surgery experienced a postoperative infection, as compared to 1.3% (1,382/102, 572) of controls (RR = 1.053 95% CI 0.704-1.575, P = 0.802). Differences in infection risk for 0-3 months and 3-6 months were not statistically significant.Conclusions:CSIs <1 month prior to lumbar spine surgery are a significant risk factor for infection, while CSIs beyond that point showed no such association. Surgeons should consider avoiding CSIs <1 month of the use of CSIs of the spine.

COVID-19 in New York state: Effects of demographics and air quality on infection and fatality

The coronavirus disease 2019 (COVID-19) has had a global impact that has been unevenly distributed among and even within countries. Multiple demographic and environmental factors have been associated with the risk of COVID-19 spread and fatality, including age, gender, ethnicity, poverty, and air quality among others. However, specific contributions of these factors are yet to be understood. Here, we attempted to explain the variability in infection, death, and fatality rates by understanding the contributions of a few selected factors. We compared the incidence of COVID-19 in New York State (NYS) counties during the first wave of infection and analyzed how different demographic and environmental variables associate with the variation observed across the counties. We observed that infection and death rates, two important COVID-19 metrics, to be highly correlated with both being highest in counties located near New York City, considered as one of the epicenters of the infection in the US. In contrast, disease fatality was found to be highest in a different set of counties despite registering a low infection rate. To investigate this apparent discrepancy, we divided the counties into three clusters based on COVID-19 infection, death, or fatality, and compared the differences in the demographic and environmental variables such as ethnicity, age, population density, poverty, temperature, and air quality in each of these clusters. Furthermore, a regression model built on this data reveals PM2.5 and distance from the epicenter are significant risk factors for infection, while disease fatality has a strong association with age and PM2.5. Our results demonstrate that for the NYS, demographic components distinctly associate with specific aspects of COVID-19 burden and also highlight the detrimental impact of poor air quality. These results could help design and direct location-specific control and mitigation strategies.

Infectious complications in patients with relapsed refractory multiple myeloma after BCMA CAR T-cell therapy

AbstractB-cell maturation antigen-targeted chimeric antigen receptor T-cell therapy (BCMA CAR-T) is an effective treatment of relapsed refractory multiple myeloma (MM). However, the pattern of infectious complications is not well elucidated. We performed a single-center retrospective analysis of infection outcomes up to 1 year after BCMA CAR-T for MM from 2018 to 2020. Fifty-five patients with MM were treated with BCMA CAR-T. Before lymphodepletion (LD), 35% of patients had severe hypogammaglobulinemia and 18% had severe lymphopenia. Most patients (68%) received bridging chemotherapy (BC) before LD. In the first month after CAR-T, 98% patients had grade 3 to 4 neutropenia. At 1 year after infusion, 76% patients had hypogammaglobulinemia. With a median follow-up of 6.0 months (95% confidence interval, 4.7-7.4), there were a total of 47 infection events in 29 (53%) patients: 40% bacterial, 53% viral, and 6% fungal. Most (92%) were mild-moderate and of the lower/upper respiratory tract system (68%). Half of the infections (53%) occurred in the first 100 days after CAR-T infusion. Although no statistically significant risk factors for infection were identified, prior lines of therapy, use of BC, recent infections, and post–CAR-T lymphopenia were identified as possible risk factors that need to be further explored. This is the largest study to date to assess infectious complications after BCMA CAR-T. Despite multiple risk factors for severe immunosuppression in this cohort, relatively few life-threatening or severe infections occurred. Further larger studies are needed to better characterize the risk factors for and occurrence of infections after BCMA CAR-T.