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Metersky ML, Wang Y, Klompas M, Eckenrode S, Mathew J, Krumholz HM. Temporal trends in postoperative and ventilator-associated pneumonia in the United States. Infect Control Hosp Epidemiol 2023; 44:1247-1254. [PMID: 36326283 DOI: 10.1017/ice.2022.264] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine change in rates of postoperative pneumonia and ventilator-associated pneumonia among patients hospitalized in the United States during 2009-2019. DESIGN Retrospective cohort study. PATIENTS Patients hospitalized for major surgical procedures, acute myocardial infarction, heart failure, and pneumonia. METHODS We conducted a retrospective review of data from the Medicare Patient Safety Monitoring System, a chart-abstraction-derived database including 21 adverse-event measures among patients hospitalized in the United States. Changes in observed and risk-adjusted rates of postoperative pneumonia and ventilator-associated pneumonia were derived. RESULTS Among 58,618 patients undergoing major surgical procedures between 2009 and 2019, the observed rate of postoperative pneumonia from 2009-2011 was 1.9% and decreased to 1.3% during 2017-2019. The adjusted annual risk each year, compared to the prior year, was 0.94 (95% CI, 0.92-0.96). Among 4,007 patients hospitalized for any of these 4 conditions at risk for ventilator-associated pneumonia during 2009-2019, we did not detect a significant change in observed or adjusted rates. Observed rates clustered around 10%, and adjusted annual risk compared to the prior year was 0.99 (95% CI, 0.95-1.02). CONCLUSIONS During 2009-2019, the rate of postoperative pneumonia decreased statistically and clinically significantly in among patients hospitalized for major surgical procedures in the United States, but rates of ventilator-associated pneumonia among patients hospitalized for major surgical procedures, acute myocardial infarction, heart failure, and pneumonia did not change.
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Affiliation(s)
- Mark L Metersky
- Division of Pulmonary, Critical Care Medicine and Sleep Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Yun Wang
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical, Harvard Medical School, Boston, Massachusetts
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sheila Eckenrode
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Jasie Mathew
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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2
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Time Trends in Patient Characteristics and In-Hospital Adverse Events for Primary Total Knee Arthroplasty in the United States: 2010-2017. Arthroplast Today 2021; 11:157-162. [PMID: 34604486 PMCID: PMC8473015 DOI: 10.1016/j.artd.2021.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 11/22/2022] Open
Abstract
Background Perioperative care for total knee arthroplasty (TKA) has improved over time. We present an analysis of inpatient safety after TKA. Methods 14,057 primary TKAs captured by the Medicare Patient Safety Monitoring System between 2010 and 2017 were retrospectively reviewed. We calculated changes in demographics, comorbidities, and adverse events (AEs) over time. Risk factors for AEs were also assessed. Results Between 2010 and 2017, there was an increased prevalence of obesity (35.1% to 57.6%), tobacco smoking (12.5% to 17.8%), and renal disease (5.2% to 8.9%). There were reductions in coronary artery disease (17.3% to 13.4%) and chronic warfarin use (6.7% to 3.1%). Inpatient AEs decreased from 4.9% to 2.5%, (P < .01), primarily driven by reductions in anticoagulant-associated AEs, including major bleeding and hematomas (from 2.8% to 1.0%, P < .001), catheter-associated urinary tract infections (1.1% to 0.2%, P < .001), pressure ulcers (0.8% to 0.2%, P < .001), and venous thromboembolism (0.3% to 0.1%, P = .04). The adjusted annual decline in the risk of developing any in-hospital AE was 14% (95% confidence interval [CI] 10%-17%). Factors associated with developing an AE were advanced age (odds ratio [OR] = 1.01, 95% CI 1.00-1.01), male sex (OR = 1.21, 95% CI 1.02-1.44), coronary artery disease (OR = 1.35, 95% CI 1.07-1.70), heart failure (OR = 1.70, 95% CI 1.20-2.41), and renal disease (OR = 1.71, 95% CI 1.23-2.37). Conclusions Despite increasing prevalence of obesity, tobacco smoking, and renal disease, inpatient AEs after primary TKA have decreased over the past several years. This improvement is despite the increasing complexity of the inpatient TKA population over time.
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Classen DC, Munier W, Verzier N, Eldridge N, Hunt D, Metersky M, Richards C, Wang Y, Brady PJ, Helwig A, Battles J. Measuring Patient Safety: The Medicare Patient Safety Monitoring System (Past, Present, and Future). J Patient Saf 2021; 17:e234-e240. [PMID: 27768654 DOI: 10.1097/pts.0000000000000322] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
ABSTRACT The explicit declaration in the landmark 1999 Institute of Medicine report "To Err Is Human" that, in the United States, 44,000 to 98,000 patients die each year as a consequence of "medical errors" gave widespread validation to the magnitude of the patient safety problem and catalyzed a number of U.S. federal government programs to measure and improve the safety of the national healthcare system. After more than 10 years, one of those federal programs, the Medicare Patient Safety Monitoring System (MPSMS), has reached a level of maturity and stability that has made it useful for the consistent measurement of the safety of inpatient care. The MPSMS is a chart review-based national patient safety surveillance system that provides rates of 21 specific hospital inpatient adverse event measures, which have been divided into 4 clinical domains (general, hospital-acquired infections, postprocedure adverse events, and adverse drug events) for analysis. The 2014 MPSMS national sample was drawn from 1109 hospitals and includes approximately 20,000 medical records of patients admitted to the hospital (all payors) for at least 1 of the 4 conditions of congestive heart failure, acute myocardial infarction, pneumonia, and major surgical procedures as defined by the Centers for Medicare and Medicaid Services Surgical Care Improvement Project. The MPSMS is now going through a major transformation to capture additional types of adverse events and is being redeveloped as the Quality and Safety Review System (QSRS). As an example of this transformation, QSRS will electronically import electronic data, which are standardized according to the Centers for Medicare and Medicaid Services billing definitions and will be updated and evolve over time to incorporate expanded standardized data available from electronic health records. This article reviews the development of MPSMS, the strengths and limitations of MPSMS, and expected future directions in patient safety measurement, focusing on those issues that are informing the development and implementation of QSRS.
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Affiliation(s)
- David C Classen
- From the Division of Clinical Epidemiology, University of Utah School of Medicine, Salt Lake City, Utah
| | - William Munier
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | | | - Noel Eldridge
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | - David Hunt
- Office of the National Coordinator for Health Information Technology, Washington, District of Columbia
| | | | | | - Yun Wang
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - P Jeffrey Brady
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | - Amy Helwig
- Agency for Healthcare Research and Quality, Rockville, Maryland
| | - James Battles
- Agency for Healthcare Research and Quality, Rockville, Maryland
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4
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Teymourzadeh E, Bahadori M, Fattahi H, Rahdar HA, Mirzaei Moghadam S, Shokri A. Prevalence and Predictive Factors for Nosocomial Infection in the Military Hospitals: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:58-68. [PMID: 34178764 PMCID: PMC8213630 DOI: 10.18502/ijph.v50i1.5072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background: To assess prevalence and predictive factors for Nosocomial Infection (NI) in the military hospitals. Methods: PubMed, Scopus, Cochrane and PreQuest databases were systematically searched for studies published between Jan 1991 and Oct 2017 that reported the prevalence of NI and predictive factors among military hospitals. We performed the meta-analysis using a random effects model. Subgroup analysis was done for heterogeneity and the Egger test to funnel plots was used to assess publication bias. Results: Twenty-eight studies with 250,374 patients were evaluated in meta-analysis. The overall pooled estimate of the prevalence of NI was 8% (95% 6.0–9.0). The pooled prevalence was 2% (95% CI: 2.0–3.0) when we did sensitivity analysis and excluding a study. The prevalence was highest in burn unit (32%) and ICU (15%). Reported risk factors for NI included gender (male vs female, OR: 1.45), age (Age≥65, OR: 2.4), diabetes mellitus (OR: 2.32), inappropriate use of antibiotics (OR: 2.35), received mechanical support (OR: 2.81), co-morbidities (OR: 2.97), admitted into the ICU (OR: 2.26), smoking (OR: 1.36) and BMI (OR: 1.09). Conclusion: The review revealed a difference of prevalence in military hospitals with other hospitals and shows a high prevalence of NI in burn units. Therefore careful disinfection and strict procedures of infection control are necessary in places that serve immunosuppressed individuals such as burn patient. Moreover, a vision for the improvement of reports and studies in military hospitals to report the rate of these infections are necessary.
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Affiliation(s)
- Ehsan Teymourzadeh
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohamadkarim Bahadori
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hamed Fattahi
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.,Center for Health Human Resources Research & Studies, Ministry of Health and Medical Education, Tehran, Iran
| | - Hossein Ali Rahdar
- Department of Microbiology, School of Medicine, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Sima Mirzaei Moghadam
- Department of Midwifery, School of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Azad Shokri
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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Ng WKY, Olmscheid N, Worhacz K, Sietsema D, Edwards S. Steroid Injection and Open Trigger Finger Release Outcomes: A Retrospective Review of 999 Digits. Hand (N Y) 2020; 15:399-406. [PMID: 30239211 PMCID: PMC7225882 DOI: 10.1177/1558944718796559] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Open surgical release of the A1 pulley is the definitive treatment for the common hand condition of trigger finger, or inflammatory stenosing tenosynovitis. Anecdotal evidence among hand surgeons has questioned whether or not recent steroid injection may be related to complications following open trigger finger release, particularly wound infection, but no studies have primarily studied this connection to date. We aimed to determine whether recent steroid injection was associated with postoperative surgical infections. Methods: We performed a retrospective chart review of 780 adult patients who had undergone open trigger finger release of 999 digits by 6 fellowship-trained hand surgeons at three affiliated hospital settings from January 1, 2014, to January 1, 2016. Data on timing of steroid injections relative to surgery, number of steroid injections, concomitant conditions, use of antibiotics, and postoperative complications including infections were gathered. Results: Steroid injection timing relative to subsequent operative intervention correlated with postoperative surgical site infection in trigger finger release. Older age and decreasing days between steroid injection and surgery correlated with infection rates. Other factors found to be associated with infection rates included smoking, use of preoperative antibiotics, and use of lidocaine with epinephrine. The other factors examined did not correlate with infection rates. Conclusions: Steroid injection, smoking, increasing age, lesser number of days between steroid injection and surgery, and use of lidocaine with epinephrine are risk factors for postoperative trigger surgical infections. We recommend careful preoperative counseling regarding higher wound healing risks for smokers, avoidance of steroid injections immediately prior to an operative date, and scheduling operative dates that tend to be greater than 80 days from the date of last steroid injection. We also recommend avoidance of epinephrine in the local anesthetic solution, as this may minimize surgical site infection risks.
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Affiliation(s)
- Wendy Kar Yee Ng
- The CORE Institute, Phoenix, AZ, USA,The University of Arizona, Phoenix, USA,Wendy Kar Yee Ng, The University of California Irvine Medical Center, Suite 650, 200 S Manchester Avenue, Orange, CA 92868, USA.
| | | | | | | | - Scott Edwards
- The CORE Institute, Phoenix, AZ, USA,The University of Arizona, Phoenix, USA
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6
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Wang Y, Eldridge N, Metersky ML, Sonnenfeld N, Rodrick D, Fine JM, Eckenrode S, Galusha DH, Tasimi A, Hunt DR, Bernheim SM, Normand SLT, Krumholz HM. Association Between Medicare Expenditures and Adverse Events for Patients With Acute Myocardial Infarction, Heart Failure, or Pneumonia in the United States. JAMA Netw Open 2020; 3:e202142. [PMID: 32259263 PMCID: PMC7139276 DOI: 10.1001/jamanetworkopen.2020.2142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
IMPORTANCE Studies have shown that adverse events are associated with increasing inpatient care expenditures, but contemporary data on the association between expenditures and adverse events beyond inpatient care are limited. OBJECTIVE To evaluate whether hospital-specific adverse event rates are associated with hospital-specific risk-standardized 30-day episode-of-care Medicare expenditures for fee-for-service patients discharged with acute myocardial infarction (AMI), heart failure (HF), or pneumonia. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used the 2011 to 2016 hospital-specific risk-standardized 30-day episode-of-care expenditure data from the Centers for Medicare & Medicaid Services and medical record-abstracted in-hospital adverse event data from the Medicare Patient Safety Monitoring System. The setting was acute care hospitals treating at least 25 Medicare fee-for-service patients for AMI, HF, or pneumonia in the United States. Participants were Medicare fee-for-service patients 65 years or older hospitalized for AMI, HF, or pneumonia included in the Medicare Patient Safety Monitoring System in 2011 to 2016. The dates of analysis were July 16, 2017, to May 21, 2018. MAIN OUTCOMES AND MEASURES Hospitals' risk-standardized 30-day episode-of-care expenditures and the rate of occurrence of adverse events for which patients were at risk. RESULTS The final study sample from 2194 unique hospitals included 44 807 patients (26.1% AMI, 35.6% HF, and 38.3% pneumonia) with a mean (SD) age of 79.4 (8.6) years, and 52.0% were women. The patients represented 84 766 exposures for AMI, 96 917 exposures for HF, and 109 641 exposures for pneumonia. Patient characteristics varied by condition but not by expenditure category. The mean (SD) risk-standardized expenditures were $22 985 ($1579) for AMI, $16 020 ($1416) for HF, and $16 355 ($1995) for pneumonia per hospitalization. The mean risk-standardized rates of occurrence of adverse events for which patients were at risk were 3.5% (95% CI, 3.4%-3.6%) for AMI, 2.5% (95% CI, 2.5%-2.5%) for HF, and 3.0% (95% CI, 2.9%-3.0%) for pneumonia. An increase by 1 percentage point in the rate of occurrence of adverse events was associated with an increase in risk-standardized expenditures of $103 (95% CI, $57-$150) for AMI, $100 (95% CI, $29-$172) for HF, and $152 (95% CI, $73-$232) for pneumonia per discharge. CONCLUSIONS AND RELEVANCE Hospitals with high adverse event rates were more likely to have high 30-day episode-of-care Medicare expenditures for patients discharged with AMI, HF, or pneumonia.
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Affiliation(s)
- Yun Wang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Noel Eldridge
- Agency for Healthcare Research and Quality, Department of Health and Human Services, Washington, DC
| | - Mark L. Metersky
- Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Connecticut School of Medicine, Farmington
| | - Nancy Sonnenfeld
- Centers for Medicare & Medicaid Services, Department of Health and Human Services, Washington, DC
| | - David Rodrick
- Agency for Healthcare Research and Quality, Department of Health and Human Services, Washington, DC
| | - Jonathan M. Fine
- Asthma, Pulmonary and Critical Medicine, Norwalk Hospital, Norwalk, Connecticut
| | | | - Deron H. Galusha
- General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - David R. Hunt
- Office of the National Coordinator for Health Information Technology, Department of Health and Human Services, Washington, DC
| | - Susannah M. Bernheim
- General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Sharon-Lise T. Normand
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Harlan M. Krumholz
- General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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7
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Clinical and microbiological profile of healthcare associated infection in a tertiary care hospital in north-eastern India. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2018. [DOI: 10.1016/j.injms.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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8
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Yang HW, Su YJ. Trends in the epidemiology of purple urine bag syndrome: A systematic review. Biomed Rep 2018. [PMID: 29564123 DOI: 10.3892/br.2018.1046.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purple urine bag syndrome (PUBS) is rarely observed in clinical practice. The present study aimed to identify the epidemiological trends in PUBS in recent decades. A search of PubMed articles published between 1980 October and 2016 August was conducted, in which 106 articles (174 cases) described PUBS. Of these cases, 58 cases were excluded: 14 cases without mention of gender, 4 cases without description of age, 37 cases without mention of white blood cell (WBC) count, shock status, fever status or description of etiology, and 3 cases without information on mortality. The remaining 116 PUBS cases were collected and analyzed in the present study. The articles were divided into three groups by publication year: 1991 to 2000, 2001 to 2010 and 2011 to 2016. The χ2 test was used for statistical analysis, with P<0.05 (two-tailed) defined as the threshold for significance. Of the total enrolled cases, there were 47 men (40.5%) and 69 women (59.5%), with a mean age ± standard deviation of 75.6±12.8 years. Of these, 98 cases (84.5%) were elderly (≥65 years old). A total of 93.1% of cases had a urine pH >7 while 6.9% of cases had acidic urine (pH <7). Furthermore, although WBC count elevated progressively, the mortality rate of patients with PUBS decreased over subsequent decades. This necessitates the advancement of antibiotics and application of early goal-directed therapy. Additionally, the overall mortality rate of PUBS (1980-2016) was 6.8%, which decreased to 4.3% in the last 5 years (2011-2016). In conclusion, although PUBS has previously been considered a benign process in the majority of indwelling catheterized patients, emphasis is required on early examination and aggressive antibiotic administration.
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Affiliation(s)
- Hsiu-Wu Yang
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan
| | - Yu-Jang Su
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan.,Department of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan.,Mackay Junior College of Medicine, Nursing and Management, New Taipei City 25245, Taiwan
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9
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Yang HW, Su YJ. Trends in the epidemiology of purple urine bag syndrome: A systematic review. Biomed Rep 2018; 8:249-256. [PMID: 29564123 PMCID: PMC5854937 DOI: 10.3892/br.2018.1046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 01/23/2018] [Indexed: 02/07/2023] Open
Abstract
Purple urine bag syndrome (PUBS) is rarely observed in clinical practice. The present study aimed to identify the epidemiological trends in PUBS in recent decades. A search of PubMed articles published between 1980 October and 2016 August was conducted, in which 106 articles (174 cases) described PUBS. Of these cases, 58 cases were excluded: 14 cases without mention of gender, 4 cases without description of age, 37 cases without mention of white blood cell (WBC) count, shock status, fever status or description of etiology, and 3 cases without information on mortality. The remaining 116 PUBS cases were collected and analyzed in the present study. The articles were divided into three groups by publication year: 1991 to 2000, 2001 to 2010 and 2011 to 2016. The χ2 test was used for statistical analysis, with P<0.05 (two-tailed) defined as the threshold for significance. Of the total enrolled cases, there were 47 men (40.5%) and 69 women (59.5%), with a mean age ± standard deviation of 75.6±12.8 years. Of these, 98 cases (84.5%) were elderly (≥65 years old). A total of 93.1% of cases had a urine pH >7 while 6.9% of cases had acidic urine (pH <7). Furthermore, although WBC count elevated progressively, the mortality rate of patients with PUBS decreased over subsequent decades. This necessitates the advancement of antibiotics and application of early goal-directed therapy. Additionally, the overall mortality rate of PUBS (1980-2016) was 6.8%, which decreased to 4.3% in the last 5 years (2011-2016). In conclusion, although PUBS has previously been considered a benign process in the majority of indwelling catheterized patients, emphasis is required on early examination and aggressive antibiotic administration.
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Affiliation(s)
- Hsiu-Wu Yang
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan
| | - Yu-Jang Su
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei 10449, Taiwan
- Department of Medicine, Mackay Medical College, New Taipei City 252, Taiwan
- Department of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei 110, Taiwan
- Mackay Junior College of Medicine, Nursing and Management, New Taipei City 25245, Taiwan
- Correspondence to: Dr Yu-Jang Su, Department of Emergency Medicine, Mackay Memorial Hospital, 92 Section 2 Chung-Shan North Road, Taipei 10449, Taiwan, E-mail:
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10
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Ma HY, Hung IC, Huang YH, Chang YY, Sheng WH, Wang JT, Chie WC, Liu JP, Chen YC. Prognostic factors of health care-associated bloodstream infection in adult patients ≥40 years of age. Am J Infect Control 2018; 46:111-114. [PMID: 28844380 DOI: 10.1016/j.ajic.2017.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 07/04/2017] [Accepted: 07/05/2017] [Indexed: 10/19/2022]
Abstract
We investigated 401 geriatric patients and 453 middle-aged patients with health care-associated bloodstream infection (HABSI) at a medical center during January-December 2014. Compared with middle-aged patients, the geriatric group had higher 30-day mortality (31.2% vs 23.4%, P = .01). Body mass index, serum albumin concentration, Charlson comorbidity index score, vancomycin-resistant Enterococcus bacteremia, and high C-reactive protein levels predict poor outcomes for HABSI among adult patients.
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11
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Bichara D, Iggidr A. Multi-patch and multi-group epidemic models: a new framework. J Math Biol 2017; 77:107-134. [PMID: 29149377 DOI: 10.1007/s00285-017-1191-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 10/26/2017] [Indexed: 12/19/2022]
Abstract
We develop a multi-patch and multi-group model that captures the dynamics of an infectious disease when the host is structured into an arbitrary number of groups and interacts into an arbitrary number of patches where the infection takes place. In this framework, we model host mobility that depends on its epidemiological status, by a Lagrangian approach. This framework is applied to a general SEIRS model and the basic reproduction number [Formula: see text] is derived. The effects of heterogeneity in groups, patches and mobility patterns on [Formula: see text] and disease prevalence are explored. Our results show that for a fixed number of groups, the basic reproduction number increases with respect to the number of patches and the host mobility patterns. Moreover, when the mobility matrix of susceptible individuals is of rank one, the basic reproduction number is explicitly determined and was found to be independent of the latter if the matrix is also stochastic. The cases where mobility matrices are of rank one capture important modeling scenarios. Additionally, we study the global analysis of equilibria for some special cases. Numerical simulations are carried out to showcase the ramifications of mobility pattern matrices on disease prevalence and basic reproduction number.
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Affiliation(s)
- Derdei Bichara
- Department of Mathematics and Center for Computational and Applied Mathematics, California State University, Fullerton, CA, 92831, USA.
| | - Abderrahman Iggidr
- Inria, Université de Lorraine, CNRS, Institut Elie Cartan de Lorraine, UMR 7502, ISGMP Bat. A, Ile du Saulcy, 57045, Metz Cedex 01, France
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12
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Conway LJ, Liu J, Harris AD, Larson EL. Risk Factors for Bacteremia in Patients With Urinary Catheter-Associated Bacteriuria. Am J Crit Care 2016; 26:43-52. [PMID: 27965229 DOI: 10.4037/ajcc2017220] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Catheter-associated bacteriuria is complicated by secondary bacteremia in 0.4% to 4.0% of cases. The directly attributable mortality rate is 12.7%. OBJECTIVE To identify risk factors for bacteremia associated with catheter-associated bacteriuria. METHODS Data were acquired from a large electronic clinical and administrative database of consecutive adult inpatient admissions to 2 acute care hospitals during a 7-year period. Data on patients with catheter-associated bacteriuria and bacteremia were compared with data on control patients with catheter-associated bacteriuria and no bacteremia, matched for date of admission plus or minus 30 days. Urine and blood cultures positive for the same pathogen within 7 days were used to define catheter-associated bacteriuria and bacteremia. Multivariable conditional logistic regression was used to determine independent risk factors for bacteremia. RESULTS The sample consisted of 158 cases and 474 controls. Independent predictors of bacteremia were male sex (odds ratio, 2.76), treatment with immunosuppressants (odds ratio, 1.68), urinary tract procedure (odds ratio, 2.70), and catheter that remained in place after bacteriuria developed (odds ratio, 2.75). Patients with enterococcal bacteriuria were half as likely to become bacteremic as were patients with other urinary pathogens (odds ratio, 0.46). Odds of secondary bacteremia increased 2% per additional day of hospital stay (95% CI, 1.01-1.04) and decreased 1% with each additional year of age (95% CI, 0.97-0.99). CONCLUSIONS The results add new information about increased risk for bacteremia among patients with catheters remaining in place after catheter-associated bacteriuria and confirm evidence for previously identified risk factors.
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Affiliation(s)
- Laurie J Conway
- Laurie J. Conway is an assistant professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada. Jianfang Liu is a senior data analyst, Columbia University School of Nursing, New York, New York. Anthony D. Harris is a professor of epidemiology and public health, School of Medicine, University of Maryland, Baltimore. Elaine L. Larson is associate dean for research and professor of therapeutic and pharmaceutical research, School of Nursing, and professor of epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
| | - Jianfang Liu
- Laurie J. Conway is an assistant professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada. Jianfang Liu is a senior data analyst, Columbia University School of Nursing, New York, New York. Anthony D. Harris is a professor of epidemiology and public health, School of Medicine, University of Maryland, Baltimore. Elaine L. Larson is associate dean for research and professor of therapeutic and pharmaceutical research, School of Nursing, and professor of epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Anthony D Harris
- Laurie J. Conway is an assistant professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada. Jianfang Liu is a senior data analyst, Columbia University School of Nursing, New York, New York. Anthony D. Harris is a professor of epidemiology and public health, School of Medicine, University of Maryland, Baltimore. Elaine L. Larson is associate dean for research and professor of therapeutic and pharmaceutical research, School of Nursing, and professor of epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Elaine L Larson
- Laurie J. Conway is an assistant professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Canada. Jianfang Liu is a senior data analyst, Columbia University School of Nursing, New York, New York. Anthony D. Harris is a professor of epidemiology and public health, School of Medicine, University of Maryland, Baltimore. Elaine L. Larson is associate dean for research and professor of therapeutic and pharmaceutical research, School of Nursing, and professor of epidemiology, Mailman School of Public Health, Columbia University, New York, New York
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13
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Risk factors for hospital-acquired infection in cancer patients in a central Chinese hospital. Am J Infect Control 2016; 44:e163-5. [PMID: 27207162 DOI: 10.1016/j.ajic.2016.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 02/17/2016] [Accepted: 02/25/2016] [Indexed: 12/29/2022]
Abstract
The present study assessed the risk factors associated with hospital-acquired infection (HAI) in a large Chinese cancer hospital. A total of 192,317 cancer inpatients were included in this study. Multivariate analysis of the associated risk factors indicated that older age, divorced and widowed status, surgical intervention, low rank surgical incision, and prolonged hospital stay were independent risk factors for HAIs in the cancer hospital.
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14
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Chen Y, Zhao JY, Shan X, Han XL, Tian SG, Chen FY, Su XT, Sun YS, Huang LY, Han L. A point-prevalence survey of healthcare-associated infection in fifty-two Chinese hospitals. J Hosp Infect 2016; 95:105-111. [PMID: 28007308 DOI: 10.1016/j.jhin.2016.08.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 08/10/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Healthcare-associated infection (HCAI) represents a major problem for patient safety worldwide. AIM To demonstrate the prevalence, causative agents, and risk factors for HCAI in Chinese hospitals. METHODS A one-day point-prevalence survey was conducted in 52 Chinese hospitals between October 2014 and March 2015. A web-based software system was developed for data entry and management. FINDINGS Among 53,939 patients surveyed, the prevalence of patients with at least one HCAI was 3.7%. Of 2182 HCAI episodes, the most frequently occurring types were lower respiratory tract infections (47.2%), followed by urinary tract infection (12.3%), upper respiratory tract infection (11.0%), and surgical site infection (6.2%). The prevalence of patients with at least one HCAI in critical care units was highest (17.1%). Device-associated infections, including ventilator-associated pneumonia, catheter-associated urinary tract infection, and central catheter-associated bloodstream infection, accounted for only 7.9% of all HCAIs. The most frequently isolated micro-organisms were Pseudomonas aeruginosa [206 infections (9.4%)], Acinetobacter baumannii [172 infections (7.9%)], Klebsiella pneumoniae [160 infections (7.3%)], and Escherichia coli [145 infections (6.6%)]. Of the survey patients (18,206/53,939), 33.8% were receiving at least one antimicrobial agent at the time of the survey. Risk factors for HCAI included older age (≥80 years), male gender, days of hospital admission, admission into a critical care unit, and device utilization. CONCLUSION Our study suggests that the overall prevalence of HCAI in surveyed Chinese hospitals was lower than that reported from most European countries and the USA. More attention should be given to the surveillance and prevention of non-device-associated HCAI in China.
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Affiliation(s)
- Y Chen
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, Beijing, China
| | - J Y Zhao
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, Beijing, China
| | - X Shan
- School of Public Health, Peking University, Beijing, China
| | - X L Han
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, Beijing, China
| | - S G Tian
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, Beijing, China
| | - F Y Chen
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, Beijing, China
| | - X T Su
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, Beijing, China
| | - Y S Sun
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, Beijing, China
| | - L Y Huang
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, Beijing, China
| | - L Han
- Institute of Disease Control and Prevention, Academy of Military Medical Sciences, Beijing, China.
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15
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Battles JB, Cleeman JI, Kahn KL, Weinberg DA. Introduction to "preventing healthcare-associated infections: results and lessons learned from AHRQ's HAI program". Infect Control Hosp Epidemiol 2014; 35 Suppl 3:S1-2. [PMID: 25222887 DOI: 10.1086/677817] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- James B Battles
- Agency for Healthcare Research and Quality, Rockville, Maryland
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