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Mortensen VH, Mygind LH, Schønheyder HC, Staus P, Wolkewitz M, Kristensen B, Søgaard M. Excess length of stay and readmission following hospital-acquired bacteraemia: a population-based cohort study applying a multi-state model approach. Clin Microbiol Infect 2023; 29:346-352. [PMID: 36150671 DOI: 10.1016/j.cmi.2022.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 09/01/2022] [Accepted: 09/09/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Population-based estimates of excess length of stay after hospital-acquired bacteraemia (HAB) are few and prone to time-dependent bias. We investigated the excess length of stay and readmission after HAB. METHODS This population-based cohort study included the North Denmark Region adult population hospitalized for ≥48 hours, from 2006 to 2018. Using a multi-state model with 45 days of follow-up, we estimated adjusted hazard ratios (aHRs) for end of stay and discharge alive. The excess length of stay was defined as the difference in residual length of stay between infected and uninfected patients, estimated using a non-parametric approach with HAB as time-dependent exposure. Confounder effects were estimated using pseudo-value regression. Readmission after HAB was investigated using the Cox regression. RESULTS We identified 3457 episodes of HAB in 484 291 admissions in 205 962 unique patients. Following HAB, excess length of stay was 6.6 days (95% CI, 6.2-7.1 days) compared with patients at risk. HAB was associated with decreased probability of end of hospital stay (aHR, 0.60; 95% CI, 0.57-0.62) driven by the decreased hazard for discharge alive; the aHRs ranged from 0.30 (95% CI, 0.23-0.40) for bacteraemia stemming from 'heart and vascular' source to 0.72 (95% CI, 0.69-0.82) for the 'urinary tract'. Despite increased post-discharge mortality (aHR, 2.76; 95% CI, 2.38-3.21), HAB was associated with readmission (aHR, 1.42; 95% CI, 1.31-1.53). CONCLUSION HAB was associated with considerably excess length of hospital stay compared with hospitalized patients without bacteraemia. Among patients discharged alive, HAB was associated with increased readmission rates.
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Affiliation(s)
- Viggo Holten Mortensen
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.
| | - Lone Hagens Mygind
- Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark; Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Carl Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Paulina Staus
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Centre, University of Freiburg, Freiburg, Germany
| | - Martin Wolkewitz
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Centre, University of Freiburg, Freiburg, Germany
| | - Brian Kristensen
- Infectious Disease Epidemiology & Prevention, National Centre for Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Mette Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
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Di Bella S, Antonello RM, Sanson G, Maraolo AE, Giacobbe DR, Sepulcri C, Ambretti S, Aschbacher R, Bartolini L, Bernardo M, Bielli A, Busetti M, Carcione D, Camarlinghi G, Carretto E, Cassetti T, Chilleri C, De Rosa FG, Dodaro S, Gargiulo R, Greco F, Knezevich A, Intra J, Lupia T, Concialdi E, Bianco G, Luzzaro F, Mauri C, Morroni G, Mosca A, Pagani E, Parisio EM, Ucciferri C, Vismara C, Luzzati R, Principe L. Anaerobic bloodstream infections in Italy (ITANAEROBY): A 5-year retrospective nationwide survey. Anaerobe 2022; 75:102583. [PMID: 35568274 DOI: 10.1016/j.anaerobe.2022.102583] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 05/01/2022] [Accepted: 05/04/2022] [Indexed: 12/26/2022]
Abstract
INTRODUCTION A lack of updated data on the burden and profile of anaerobic bloodstream infections (ABIs) exists. We assessed the incidence of ABIs and trends in antimicrobial resistance in anaerobes isolated from blood in Italy. MATERIAL AND METHODS We conducted a retrospective study on 17 Italian hospitals (2016-2020). Anaerobes isolated from blood culture and their in vitro susceptibility profiles (EUCAST-interpreted) were registered and analyzed. RESULTS A total of 1960 ABIs were identified. The mean age of ABIs patients was 68.6 ± 18.5 years, 57.6% were males. The overall incidence rate of ABIs was 1.01 per 10.000 patient-days. Forty-seven% of ABIs occurred in medical wards, 17% in ICUs, 14% in surgical wards, 7% in hemato-oncology, 14% in outpatients. The three most common anti-anaerobic tested drugs were metronidazole (92%), clindamycin (89%) and amoxicillin/clavulanate (83%). The three most common isolated anaerobes were Bacteroides fragilis (n = 529), Cutibacterium acnes (n = 262) and Clostridium perfringens (n = 134). The lowest resistance rate (1.5%) was to carbapenems, whereas the highest rate (51%) was to penicillin. Clindamycin resistance was >20% for Bacteroides spp., Prevotella spp. and Clostridium spp. Metronidazole resistance was 9.2% after excluding C. acnes and Actinomyces spp. Bacteroides spp. showed an increased prevalence of clindamycin resistance through the study period: 19% in 2016, 33% in 2020 (p ≤ 0.001). CONCLUSIONS Our data provide a comprehensive overview of the epidemiology of ABIs in Italy, filling a gap that has existed since 1995. Caution is needed when clindamycin is used as empirical anti-anaerobic drug.
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Affiliation(s)
- Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Roberta Maria Antonello
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Gianfranco Sanson
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | | | - Daniele Roberto Giacobbe
- San Martino Polyclinic Hospital IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy.
| | - Chiara Sepulcri
- San Martino Polyclinic Hospital IRCCS, Genoa, Italy; Department of Health Sciences, University of Genoa, Genoa, Italy.
| | - Simone Ambretti
- University Hospital of Bologna-Policlinico Sant'Orsola-Malpighi, Microbiology and Virology Unit, Bologna, Italy.
| | - Richard Aschbacher
- Laboratorio Aziendale di Microbiologia e Virologia, Comprensorio Sanitario di Bolzano, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy.
| | - Laura Bartolini
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy.
| | - Mariano Bernardo
- Microbiology Unit, AORN Ospedali dei Colli-Monaldi Hospital, Naples, Italy.
| | - Alessandra Bielli
- Clinical Pathology and Microbiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Marina Busetti
- Microbiology and Virology Unit, University Hospital of Trieste, Trieste, Italy.
| | - Davide Carcione
- Department of Laboratory Medicine, University of Milano-Bicocca, ASST-Brianza, Desio Hospital, Desio, Italy.
| | - Giulio Camarlinghi
- Clinical Pathology and Microbiology Unit, San Luca Hospital, Lucca, Italy.
| | - Edoardo Carretto
- Clinical Microbiology Laboratory, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy.
| | - Tiziana Cassetti
- Clinical Microbiology and Virology Unit, AOU Policlinico, Modena, Italy.
| | - Chiara Chilleri
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy.
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy; Unit of Infectious Diseases, Cardinal Massaia Hospital, Asti, Italy.
| | - Saveria Dodaro
- Microbiology and Virology Unit, "Annunziata" Hospital of Cosenza, Cosenza, Italy.
| | - Raffaele Gargiulo
- Clinical Microbiology and Virology Unit, AOU Policlinico, Modena, Italy.
| | - Francesca Greco
- Microbiology and Virology Unit, "Annunziata" Hospital of Cosenza, Cosenza, Italy
| | - Anna Knezevich
- Microbiology and Virology Unit, University Hospital of Trieste, Trieste, Italy.
| | - Jari Intra
- Department of Laboratory Medicine, University of Milano-Bicocca, ASST-Brianza, Desio Hospital, Desio, Italy.
| | - Tommaso Lupia
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy; Unit of Infectious Diseases, Cardinal Massaia Hospital, Asti, Italy.
| | | | - Gabriele Bianco
- Microbiology and Virology Unit, Città della Salute e della Scienza di Torino, University of Turin, Italy.
| | - Francesco Luzzaro
- Clinical Microbiology and Virology Unit, "A. Manzoni" Hospital, Lecco, Italy.
| | - Carola Mauri
- Clinical Microbiology and Virology Unit, "A. Manzoni" Hospital, Lecco, Italy
| | - Gianluca Morroni
- Microbiology Unit, Department of Biomedical Sciences and Public Health, Polytechnic University of Marche Medical School, Ancona, Italy.
| | - Adriana Mosca
- Interdisciplinary Department of Medicine (DIM), University of Bari "Aldo Moro", Policlinico, Bari, Italy.
| | - Elisabetta Pagani
- Laboratorio Aziendale di Microbiologia e Virologia, Comprensorio Sanitario di Bolzano, Azienda Sanitaria dell'Alto Adige, Bolzano, Italy
| | - Eva Maria Parisio
- Clinical Pathology and Microbiology Unit, San Luca Hospital, Lucca, Italy.
| | - Claudio Ucciferri
- Clinic of Infectious Diseases, Department of Medicine and Science of Aging, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy.
| | - Chiara Vismara
- Clinical Pathology and Microbiology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Roberto Luzzati
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Luigi Principe
- Clinical Pathology and Microbiology Unit, "San Giovanni di Dio" Hospital, Crotone, Italy.
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Mortensen VH, Søgaard M, Mygind LH, Wolkewitz M, Kristensen B, Schønheyder HC. Incidence and mortality of hospital-acquired bacteraemia: A population-based cohort study applying a multi-state model approach. Clin Microbiol Infect 2021; 28:879.e9-879.e15. [PMID: 34929409 DOI: 10.1016/j.cmi.2021.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 12/09/2021] [Accepted: 12/11/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The effect of hospital-acquired bacteraemia on mortality is sparsely investigated. We investigated the incidence and hospital-acquired bacteraemia impact on mortality. METHODS We conducted a 13-year population-based cohort study using The North Denmark Bacteraemia Research Database and Danish health registries. The population comprised all adult patients with a hospital admission lasting ≥48 hours. We used Poisson regression to estimate trends in incidence. The 30-day mortality of hospital-acquired bacteraemia was estimated using an illness-death multi-state model with recovery using the population at risk of hospital-acquired bacteraemia as reference. RESULTS We identified 3,588 episodes of hospital-acquired bacteraemia in 484,264 admissions. The incidence increased proportionally by 1.02 episodes yearly (95% CI 1.01 - 1.03) between 2006 and 2018. Hospital-acquired bacteraemia was associated with increased mortality (adjusted hazard ratio (aHR) 4.32, 95% CI 3.95 - 4.72), especially hospital-acquired bacteraemia with unknown source (aHR 6.42 (95% CI 5.67 - 7.26), 'thoracic incl. pneumonia' (aHR 5.89, 95% CI 3.45 - 10.12), and abdominal source (aHR 4.33, 95% CI 3.27 - 5.74)95% CI95% CI. The relative impact on mortality diminished with age (aHR 5.66, 95% CI 2.00 - 16.01 in 18-40 years old vs. 3.69, 95% CI 3.14 - 4.32 in 81-105 years old) and comorbidity (aHR 5.75, 95% CI 4.45 - 7.42 in low vs. 3.55, 95% CI 3.16 -3.98 in high comorbidity), and was higher in elective admissions (aHR 9.09, 95% CI 7.14 - 11.57 vs. aHR of 4.03, 95% CI 3.67 - 4.42). CONCLUSIONS Hospital-acquired bacteraemia is associated with high mortality, especially when the source is unknown or originating from the thoracic cavity.
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Affiliation(s)
- Viggo Holten Mortensen
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark.
| | - Mette Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Lone Hagens Mygind
- Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark; Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Martin Wolkewitz
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Centre, University of Freiburg, Freiburg, Germany
| | - Brian Kristensen
- Infectious Disease Epidemiology & Prevention, National Centre for Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Henrik Carl Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
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Richelsen R, Smit J, Schønheyder HC, Laxsen Anru P, Gutiérrez-Gutiérrez B, Rodríguez-Bãno J, Nielsen H. Outcome of community-onset ESBL-producing Escherichia coli and Klebsiella pneumoniae bacteraemia and urinary tract infection: a population-based cohort study in Denmark. J Antimicrob Chemother 2021; 75:3656-3664. [PMID: 32862220 DOI: 10.1093/jac/dkaa361] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/20/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To assess the impact of ESBL production on mortality and length of hospital stay (LOS) of community-onset infections due to Escherichia coli or Klebsiella pneumoniae. METHODS A population-based cohort study including all adult patients hospitalized with a first-time community-onset E. coli or K. pneumoniae bacteraemia or urinary tract infection in the North Denmark Region between 2007 and 2017. For each bacterial agent, we computed 1 year Kaplan-Meier survival curves and cumulative incidence functions of LOS, and by use of Cox proportional hazard regression we computed HRs as estimates of 30 day and 1 year mortality rate ratios (MRRs) and LOS among patients with and without ESBL-producing infections. RESULTS We included 24 518 cases (among 22350 unique patients), of whom 1018 (4.2%) were infected by an ESBL-producing bacterium. The 30 day cumulative mortality and adjusted MRR (aMRR) in patients with and without ESBL-producing isolates was as follows: E. coli bacteraemia (n = 3831), 15.8% versus 14.0%, aMRR = 1.01 (95% CI = 0.70-1.45); E. coli urinary tract infection (n = 17151), 9.5% versus 8.7%, aMRR = 0.97 (95% CI = 0.75-1.26); K. pneumoniae bacteraemia (n = 734), 0% versus 17.2%, aMRR = not applicable; and K. pneumoniae urinary tract infection (n = 2802), 13.8% versus 10.7%, aMRR = 1.13 (95% CI = 0.73-1.75). The 1 year aMRR remained roughly unchanged. ESBL-producing E. coli bacteraemia was associated with an increased LOS compared with non-ESBL production. CONCLUSIONS ESBL production was not associated with an increased short- or long-term mortality in community-onset infections due to E. coli or K. pneumoniae, yet ESBL-producing E. coli bacteraemia was associated with an increased LOS.
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Affiliation(s)
- Rasmus Richelsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Jesper Smit
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Henrik Carl Schønheyder
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Belen Gutiérrez-Gutiérrez
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - Jesús Rodríguez-Bãno
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena/Departamento de Medicina, Universidad de Sevilla/Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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5
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Horváth-Puhó E, van Kassel MN, Gonçalves BP, de Gier B, Procter SR, Paul P, van der Ende A, Søgaard KK, Hahné SJM, Chandna J, Schrag SJ, van de Beek D, Jit M, Sørensen HT, Bijlsma MW, Lawn JE. Mortality, neurodevelopmental impairments, and economic outcomes after invasive group B streptococcal disease in early infancy in Denmark and the Netherlands: a national matched cohort study. THE LANCET CHILD & ADOLESCENT HEALTH 2021; 5:398-407. [PMID: 33894156 PMCID: PMC8131199 DOI: 10.1016/s2352-4642(21)00022-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/04/2021] [Accepted: 01/08/2021] [Indexed: 02/07/2023]
Abstract
Background Group B Streptococcus (GBS) disease is a leading cause of neonatal death, but its long-term effects have not been studied after early childhood. The aim of this study was to assess long-term mortality, neurodevelopmental impairments (NDIs), and economic outcomes after infant invasive GBS (iGBS) disease up to adolescence in Denmark and the Netherlands. Methods For this cohort study, children with iGBS disease were identified in Denmark and the Netherlands using national medical and administrative databases and culture results that confirmed their diagnoses. Exposed children were defined as having a history of iGBS disease (sepsis, meningitis, or pneumonia) by the age of 89 days. For each exposed child, ten unexposed children were randomly selected and matched by sex, year and month of birth, and gestational age. Mortality data were analysed with the use of Cox proportional hazards models. NDI data up to adolescence were captured from discharge diagnoses in the National Patient Registry (Denmark) and special educational support records (the Netherlands). Health care use and household income were also compared between the exposed and unexposed cohorts. Findings 2258 children—1561 in Denmark (born from Jan 1, 1997 to Dec 31, 2017) and 697 in the Netherlands (born from Jan 1, 2000 to Dec 31, 2017)—were identified to have iGBS disease and followed up for a median of 14 years (IQR 7–18) in Denmark and 9 years (6–11) in the Netherlands. 366 children had meningitis, 1763 had sepsis, and 129 had pneumonia (in Denmark only). These children were matched with 22 462 children with no history of iGBS disease. iGBS meningitis was associated with an increased mortality at age 5 years (adjusted hazard ratio 4·08 [95% CI 1·78–9·35] for Denmark and 6·73 [3·76–12·06] for the Netherlands). Any iGBS disease was associated with an increased risk of NDI at 10 years of age, both in Denmark (risk ratio 1·77 [95% CI 1·44–2·18]) and the Netherlands (2·28 [1·64–3·17]). A history of iGBS disease was associated with more frequent outpatient clinic visits (incidence rate ratio 1·93 [95% CI 1·79–2·09], p<0·0001) and hospital admissions (1·33 [1·27–1·38], p<0·0001) in children 5 years or younger. No differences in household income were observed between the exposed and unexposed cohorts. Interpretation iGBS disease, especially meningitis, was associated with increased mortality and a higher risk of NDIs in later childhood. This previously unquantified burden underlines the case for a maternal GBS vaccine, and the need to track and provide care for affected survivors of iGBS disease. Funding The Bill & Melinda Gates Foundation. Translations For the Dutch and Danish translations of the abstract see Supplementary Materials section.
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Affiliation(s)
| | - Merel N van Kassel
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Bronner P Gonçalves
- Maternal, Adolescent, Reproductive & Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Brechje de Gier
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Simon R Procter
- Maternal, Adolescent, Reproductive & Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Proma Paul
- Maternal, Adolescent, Reproductive & Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Arie van der Ende
- Netherlands Reference Laboratory for Bacterial Meningitis, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; The National Institute for Public Health and the Environment, University of Amsterdam, Amsterdam, Netherlands; Department of Medical Microbiology and Infection Prevention, Amsterdam Infection and Immunity, Amsterdam, Netherlands
| | - Kirstine K Søgaard
- Department of Clinical Epidemiology, Aarhus University, Aarhus N, Denmark; Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | - Susan J M Hahné
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Jaya Chandna
- Maternal, Adolescent, Reproductive & Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Stephanie J Schrag
- Division of Bacterial Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Diederik van de Beek
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Mark Jit
- Maternal, Adolescent, Reproductive & Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University, Aarhus N, Denmark
| | - Merijn W Bijlsma
- Department of Neurology, Amsterdam Neuroscience, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands; Department of Paediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
| | - Joy E Lawn
- Maternal, Adolescent, Reproductive & Child Health Centre and Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.
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Søgaard KK, Veres K, Vandenbroucke-Grauls CMJE, Vandenbroucke JP, Sørensen HT, Schønheyder HC. Community-Acquired Escherichia coli Bacteremia after Age 50 and Subsequent Incidence of a Cancer Diagnosis: A Danish Population-Based Cohort Study. Cancer Epidemiol Biomarkers Prev 2020; 29:2626-2632. [PMID: 32998944 DOI: 10.1158/1055-9965.epi-20-0705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/03/2020] [Accepted: 09/25/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Community-acquired bacteremia (CAB) with Escherichia coli may signal occult cancer. This might differ between phylogenetic groups. METHODS We conducted a population-based cohort study in northern Denmark (1994-2013) to examine whether E. coli CAB after age 50 is associated with incident cancer. We followed patients from their bacteremia diagnosis date to identify subsequent gastrointestinal, hepatobiliary, and urinary tract cancer diagnoses. We calculated 1- and 5-year cumulative cancer incidence. We compared the observed incidence with that expected based on national cancer incidence rates, and computed standardized incidence ratios (SIR) at 0-<1 year and ≥1 year. In a subcohort, we assessed the prevalence of phylogenetic groups. RESULTS Among 2,735 patients with E. coli CAB, 173 later were diagnosed with cancer. The 1-year cumulative incidence of a gastrointestinal or hepatobiliary tract cancer was 1.9%, and the 0-<1-year SIR was 5.44 [95% confidence interval (CI), 4.06-7.14]. For urinary tract cancer, the corresponding estimates were 1.0% and 3.41 (95% CI, 2.27-4.93). All individual cancers occurred more often than expected during the first year following E. coli CAB, but thereafter the relative risks declined toward unity. Still, the ≥1-year SIR for colorectal cancer remained 1.4-fold elevated, and the SIR for liver, pancreas, gallbladder, and biliary tract cancer was 2-fold elevated. The prevalence of phylogenetic groups was similar among patients with and without cancer. CONCLUSIONS Gastrointestinal, hepatobiliary, and urinary tract cancer may debut with E. coli CAB. IMPACT Owing to the high incidence of E. coli bacteremia, cancers missed at the time of bacteremia diagnosis represent a clinically significant problem.
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Affiliation(s)
- Kirstine K Søgaard
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark. .,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Katalin Veres
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jan P Vandenbroucke
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik C Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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7
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Shima H, Okamoto T, Tashiro M, Inoue T, Masaki C, Tanaka Y, Tada H, Takamatsu N, Wariishi S, Kawahara K, Okada K, Nishiuchi T, Minakuchi J. Clinical Characteristics and Risk Factors for Mortality due to Bloodstream Infection of Unknown Origin in Hemodialysis Patients: A Single-Center, Retrospective Study. Blood Purif 2020; 50:238-245. [PMID: 32892202 DOI: 10.1159/000510291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 07/17/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Hemodialysis patients are at a high risk of bloodstream infection (BSI). The risk factors for BSI-associated mortality, especially of unknown origin, remain uncertain. BSI of unknown origin is highly prevalent and related to high mortality. The present study aimed to investigate the clinical and microbiological characteristics of BSI and risk factors for BSI-associated mortality, including BSI of unknown origin, in hemodialysis patients. METHODS This study was a single-center, retrospective study conducted from August 2012 to July 2019 in hemodialysis patients with BSI at Kawashima Hospital. Data related to demographics, clinical parameters, BSI sources, causative microorganisms, and initial treatments were collected from the medical records. The predictors for mortality associated with BSI were evaluated by logistic regression. RESULTS Among 174 patients, 55 (30.9%) had the infection from unknown origin. The most frequent bacterium was Staphylococcus aureus. Low serum albumin level was an independent predictor of mortality due to BSI (odds ratio [OR]: 0.28, 95% confidence interval [CI]: 0.13-0.59). A lower serum albumin level (≤2.5 g/dL) was associated with poorer mortality. Methicillin-resistant Staphylococcus aureus (MRSA) was independently associated with mortality due to BSI of unknown origin (OR: 6.20, 95% CI: 1.04-37.1); 87.5% cases with BSI of unknown origin due to MRSA were not initially administrated anti-MRSA antibiotics, and in such patients, the mortality rate was 85.7%. CONCLUSIONS Serum albumin level of 2.5 g/dL is a cutoff value, which could predict the mortality due to BSI in hemodialysis patients. Considering the high mortality rate of MRSA-associated BSI of unknown origin, wherein no focus of infection was identified in the present study, initial empiric treatment should be considered for MRSA-associated BSI of unknown origin.
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Affiliation(s)
- Hisato Shima
- Department of Kidney Disease, Kawashima Hospital, Tokushima, Japan,
| | - Takuya Okamoto
- Department of Laboratory, Kawashima Hospital, Tokushima, Japan
| | - Manabu Tashiro
- Department of Kidney Disease, Kawashima Hospital, Tokushima, Japan
| | - Tomoko Inoue
- Department of Kidney Disease, Kawashima Hospital, Tokushima, Japan
| | - Chiaki Masaki
- Department of Laboratory, Kawashima Hospital, Tokushima, Japan
| | - Yusaku Tanaka
- Clinical Engineering Department, Kawashima Hospital, Tokushima, Japan
| | - Hiroaki Tada
- Department of Laboratory, Kawashima Hospital, Tokushima, Japan
| | | | - Seiichiro Wariishi
- Department of Cardiovascular Surgery, Kawashima Hospital, Tokushima, Japan
| | | | - Kazuyoshi Okada
- Department of Kidney Disease, Kawashima Hospital, Tokushima, Japan
| | - Takeshi Nishiuchi
- Department of Cardiovascular Medicine, Kawashima Hospital, Tokushima, Japan
| | - Jun Minakuchi
- Department of Kidney Disease, Kawashima Hospital, Tokushima, Japan
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8
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Arendt JFH, Hansen AT, Ladefoged SA, Sørensen HT, Pedersen L, Adelborg K. Existing Data Sources in Clinical Epidemiology: Laboratory Information System Databases in Denmark. Clin Epidemiol 2020; 12:469-475. [PMID: 32547238 PMCID: PMC7244445 DOI: 10.2147/clep.s245060] [Citation(s) in RCA: 89] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 03/26/2020] [Indexed: 11/23/2022] Open
Abstract
Routine biomarker results from hospital laboratory information systems, covering hospitals and general practitioners, in Denmark are available to researchers through access to the regional Clinical Laboratory Information System Research Database at Aarhus University and the nationwide Register of Laboratory Results for Research. This review describes these two data sources. The laboratory databases have different geographical and temporal coverage. They both include individual-level biomarker results that are electronically transferred from laboratory information systems. The biomarker results can be linked to all other Danish registries at the individual level, using the unique identifier, the CPR number. The databases include variables such as the CPR number, date and time (hour and minute) of sampling, NPU code, and name of the biomarker, identification code for the laboratory and the requisitioner, the test result with the corresponding unit, and the lower and upper reference limits. Access to the two databases differs since they are hosted by two different institutions. Data cannot be transferred outside Denmark, and direct access is provided only to Danish institutions. It is concluded that access to data on routine biomarkers expands the detailed biological and clinical information available on patients in the Danish healthcare system. The full potential is enabled through linkage to other Danish healthcare registries.
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Affiliation(s)
- Johan Frederik Håkonsen Arendt
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Anette Tarp Hansen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark
| | | | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Lars Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kasper Adelborg
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
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9
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Todorovic Markovic M, Pedersen C, Gottfredsson M, Todorovic Mitic M, Gaini S. Focus of infection and microbiological etiology in community-acquired infections in hospitalized adult patients in the Faroe Islands. BMC Infect Dis 2019; 19:16. [PMID: 30612543 PMCID: PMC6322335 DOI: 10.1186/s12879-018-3650-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/21/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The aim of the present study was to gain national data on the clinical and microbiological characteristics of community-acquired infections in the Faroe Islands and to compare these data with data from other geographical areas. METHODS A prospective, observational study involving all patients > = 16 years admitted at the Department of Medicine at the National Hospital, Torshavn, Faroe Islands from October 2013 until April 2015. RESULTS Of 5279 admissions, 1054 cases were with community-acquired infection and were included in the study. Out of these 1054 cases, 471 did not meet the criteria for SIRS (Systemic Inflammatory Response Syndrome), while the remaining 583 cases had sepsis. Mean age was 68 years. At least one comorbidity was found in 80% of all cases. Documented infections were present in 75%, and a plausible pathogen was identified in 29% of all cases. The most common gram-positive pathogen was Staphylococcus aureus, and the most frequent gram-negative pathogen was Escherichia coli. The most common focus of infection was lower respiratory tract, followed by urinary tract, and skin-soft tissue/bone-joint. Bacteremia was found in 10% of the cases. CONCLUSION In community-acquired infections in hospitalized patients in the Faroe Islands the lower respiratory tract and the urinary tract were the most frequent foci of infection. Gram-negative pathogens and Escherichia coli were the most frequent pathogens in infection without Systemic Inflammatory Response Syndrome, in sepsis and in bacteremia. Our data on clinical characteristics and microbiological etiology provide new information which may be used to develop local guidelines for the managing of patients admitted with community-acquired infections.
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Affiliation(s)
- Marija Todorovic Markovic
- Medical Department, Infectious Diseases Division, National Hospital of the Faroe Islands, JC. Svabosgøta 41-49, Tórshavn, Faroe Islands
- Department of Infectious Diseases, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Court Pedersen
- Department of Infectious Diseases, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Magnús Gottfredsson
- Department of Infectious Diseases, Landspitali University Hospital, Reykjavík, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Shahin Gaini
- Medical Department, Infectious Diseases Division, National Hospital of the Faroe Islands, JC. Svabosgøta 41-49, Tórshavn, Faroe Islands
- Department of Infectious Diseases, Odense University Hospital and University of Southern Denmark, Odense, Denmark
- Centre of Health Research and Department of Science and Technology, University of the Faroe Islands, Torshavn, Faroe Islands
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10
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Validation of the REGARDS Severe Sepsis Risk Score. J Clin Med 2018; 7:jcm7120536. [PMID: 30544923 PMCID: PMC6306847 DOI: 10.3390/jcm7120536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/04/2018] [Accepted: 12/07/2018] [Indexed: 12/29/2022] Open
Abstract
There are no validated systems for characterizing long-term risk of severe sepsis in community-dwelling adults. We tested the ability of the REasons for Geographic and Racial Differences in Stroke-Severe Sepsis Risk Score (REGARDS-SSRS) to predict 10-year severe sepsis risk in separate cohorts of community-dwelling adults. We internally tested the REGARDS-SSRS on the REGARDS-Medicare subcohort. We then externally validated the REGARDS-SSRS using (1) the Cardiovascular Health Study (CHS) and (2) the Atherosclerosis Risk in Communities (ARIC) cohorts. Participants included community-dwelling adults: REGARDS-Medicare, age ≥65 years, n = 9522; CHS, age ≥65 years, n = 5888; ARIC, age 45–64 years, n = 11,584. The primary exposure was 10-year severe sepsis risk, predicted by the REGARDS-SSRS from participant sociodemographics, health behaviors, chronic medical conditions and select biomarkers. The primary outcome was first severe sepsis hospitalizations, defined as the concurrent presence of ICD-9 discharge diagnoses for a serious infection and organ dysfunction. Median SSRS in the cohorts were: REGARDS-Medicare 11 points (IQR 7–16), CHS 10 (IQR 6–15), ARIC 7 (IQR 5–10). Severe sepsis incidence rates were: REGARDS-Medicare 30.7 per 1000 person-years (95% CI: 29.2–32.2); CHS 11.9 (10.9–12.9); ARIC 6.8 (6.3–7.3). SSRS discrimination for first severe sepsis events were: REGARDS-Medicare C-statistic 0.704 (95% CI: 0.691–0.718), CHS 0.696 (0.675–0.716), ARIC 0.697 (0.677–0.716). The REGARDS-SRSS may potentially play a role in identifying community-dwelling adults at high severe sepsis risk.
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11
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National Automated Surveillance of Hospital-Acquired Bacteremia in Denmark Using a Computer Algorithm. Infect Control Hosp Epidemiol 2017; 38:559-566. [PMID: 28274300 DOI: 10.1017/ice.2017.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND In 2015, Denmark launched an automated surveillance system for hospital-acquired infections, the Hospital-Acquired Infections Database (HAIBA). OBJECTIVE To describe the algorithm used in HAIBA, to determine its concordance with point prevalence surveys (PPSs), and to present trends for hospital-acquired bacteremia SETTING Private and public hospitals in Denmark METHODS A hospital-acquired bacteremia case was defined as at least 1 positive blood culture with at least 1 pathogen (bacterium or fungus) taken between 48 hours after admission and 48 hours after discharge, using the Danish Microbiology Database and the Danish National Patient Registry. PPSs performed in 2012 and 2013 were used for comparison. RESULTS National trends showed an increase in HA bacteremia cases between 2010 and 2014. Incidence was higher for men than women (9.6 vs 5.4 per 10,000 risk days) and was highest for those aged 61-80 years (9.5 per 10,000 risk days). The median daily prevalence was 3.1% (range, 2.1%-4.7%). Regional incidence varied from 6.1 to 8.1 per 10,000 risk days. The microorganisms identified were typical for HA bacteremia. Comparison of HAIBA with PPS showed a sensitivity of 36% and a specificity of 99%. HAIBA was less sensitive for patients in hematology departments and intensive care units. Excluding these departments improved the sensitivity of HAIBA to 44%. CONCLUSIONS Although the estimated sensitivity of HAIBA compared with PPS is low, a PPS is not a gold standard. Given the many advantages of automated surveillance, HAIBA allows monitoring of HA bacteremia across the healthcare system, supports prioritizing preventive measures, and holds promise for evaluating interventions. Infect Control Hosp Epidemiol 2017;38:559-566.
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12
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Skov Dalgaard L, Nørgaard M, Povlsen JV, Morrissey O, Jespersen B, Jensen-Fangel S, Østergaard LJ, Schønheyder HC, Søgaard OS. Risk and prognosis of bacteremia and fungemia among first-time kidney transplant recipients: a population-based cohort study. Infect Dis (Lond) 2016; 49:286-295. [PMID: 27822975 DOI: 10.1080/23744235.2016.1248483] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Bacterial infections are common complications in kidney transplant recipients (KTRs). Little is known about incidence rates of bacteremia and fungemia (BAF) in KTRs. METHODS In this population-based cohort study, we used medical and administrative registries to identify episodes of BAF among KTRs in the Central Denmark and North Denmark Regions during 1995-2010. KTRs were followed from the date of their first transplantation to the earliest of BAF, graft loss, death, emigration or 31 December 2010. We calculated incidence rates of first BAF episode overall and stratified by time from transplantation. Potential risk factors were assessed using Cox regression analysis. The Kaplan-Meier analysis was used to estimate 30- and 90-day mortality. RESULTS Among 612 KTRs, we identified 138 first episodes of bacteremia during 2397 person-years of follow-up (PYFU). The overall incidence rate (IR) was 5.8 BAF episodes per 100 PYFU (95% confidence interval [CI]: 4.9-6.8). The incidence rate declined from 84.0 per 100 PYFU (95% CI: 61.6-114.5) during post-transplant day 0-30 to 2.3 per 100 PYFU (95% CI: 1.7-3.0) from post-transplant day 365 and onwards. Hospital-onset BAF comprised 39% of the episodes of BAF. The most frequently isolated microorganisms were Escherichia coli and Klebsiella species causing 49 (35.5%) and 29 (21.0%) episodes of BAF, respectively. The 30-day mortality was 2.1% (95% CI: 0.7-6.6). CONCLUSIONS While the risk of BAF in KTRs was high, thirty-day mortality was low. After the first post-transplant year, the IR of bacteremia was substantially lower than in the immediate post-transplant period.
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Affiliation(s)
- Lars Skov Dalgaard
- a Department of Infectious Diseases , Aarhus University Hospital , Aarhus , Denmark
| | - Mette Nørgaard
- b Department of Clinical Epidemiology , Aarhus University Hospital , Aarhus , Denmark
| | | | - Orla Morrissey
- d Department of Infectious Diseases , Alfred Health and Monash University , Melbourne , Australia
| | - Bente Jespersen
- c Department of Nephrology , Aarhus University Hospital , Aarhus , Denmark
| | - Søren Jensen-Fangel
- a Department of Infectious Diseases , Aarhus University Hospital , Aarhus , Denmark
| | - Lars J Østergaard
- a Department of Infectious Diseases , Aarhus University Hospital , Aarhus , Denmark
| | - Henrik Carl Schønheyder
- e Department of Clinical Microbiology , Aalborg University Hospital , Aalborg , Denmark.,f Department of Clinical Medicine , Aalborg University , Aalborg , Denmark
| | - Ole Schmeltz Søgaard
- a Department of Infectious Diseases , Aarhus University Hospital , Aarhus , Denmark
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13
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Seasonal Variation of Escherichia coli, Staphylococcus aureus, and Streptococcus pneumoniae Bacteremia According to Acquisition and Patient Characteristics: A Population-Based Study. Infect Control Hosp Epidemiol 2016; 37:946-953. [PMID: 27142942 DOI: 10.1017/ice.2016.89] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Seasonal variation is a characteristic of many infectious diseases, but relatively little is known about determinants thereof. We studied the impact of place of acquisition and patient characteristics on seasonal variation of bacteremia caused by the 3 most common pathogens. DESIGN Seasonal variation analysis. METHODS In 3 Danish health regions (2.3 million total inhabitants), patients with bacteremia were identified from 2000 through 2011 using information from laboratory information systems. Analyses were confined to Escherichia coli, Staphylococcus aureus, and Streptococcus pneumoniae. Additional data were obtained from the Danish National Hospital Registry for the construction of admission histories and calculation of the Charlson comorbidity index (CCI). Bacteremias were categorized as community acquired, healthcare associated (HCA), and hospital acquired. We defined multiple subgroups by combining the following characteristics: species, acquisition, age group, gender, CCI level, and location of infection. Assuming a sinusoidal model, seasonal variation was assessed by the peak-to-trough (PTT) ratio with a 95% confidence interval (CI). RESULTS In total, we included 16,006 E. coli, 6,924 S. aureus, and 4,884 S. pneumoniae bacteremia cases. For E. coli, the seasonal variation was highest for community-acquired cases (PTT ratio, 1.24; 95% CI, 1.17-1.32), was diminished for HCA (PTT ratio, 1.14; 95% CI, 1.04-1.25), and was missing for hospital-acquired cases. No seasonal variation was observed for S. aureus. S. pneumoniae showed high seasonal variation, which did not differ according to acquisition (overall PTT ratio, 3.42; 95% CI, 3.10-3.83). CONCLUSIONS Seasonal variation was mainly related to the species although the place of acquisition was important for E. coli. Infect Control Hosp Epidemiol 2016;37:946-953.
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14
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Wu JN, Gan TE, Zhu YX, Cao JM, Ji CH, Wu YH, Lv B. Epidemiology and microbiology of nosocomial bloodstream infections: analysis of 482 cases from a retrospective surveillance study. J Zhejiang Univ Sci B 2015; 16:70-7. [PMID: 25559958 DOI: 10.1631/jzus.b1400108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In many traditional Chinese medicine (TCM) hospitals, most patients are elderly with chronic diseases. Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality. A retrospective surveillance study was performed to examine the epidemiology and microbiology of nBSIs in a TCM hospital from 2009 to 2011. A total of 482 patients with nBSIs were included in the study period. The incidence rate was 5.7/1000 admissions. Escherichia coli (25.5%) was the most common Gram-negative and coagulase-negative staphylococcus (CoNS) (14.1%) was the most common Gram-positive organism isolated. One-third of the E. coli and Klebsiella pneumoniae isolated from the nBSIs were the third-generation cephalosporin-resistant. Half of the Acinetobacter species isolates were resistant to imipenem. Of all the CoNS isolates, 90.7% were resistant to methicillin. Carbapenems and glycopeptide were the most frequently used for nBSI therapy. Only about one-third of patients (157/482) received appropriate empirical therapy. Septic shock, hemodialysis, Pitt bacteremia score >4, urinary tract infection, and appropriate empirical therapy were most strongly associated with 28-d mortality. The incidence of nBSIs was low in the TCM hospital but the proportion of nBSIs due to antibiotic-resistant organisms was high. A high Pitt bacteremia score was one of the most important risk factors for mortality in nBSIs. Therefore, the implementation of appropriate empirical therapy is crucial to improve the clinical outcome of nBSIs.
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Affiliation(s)
- Jian-nong Wu
- Department of Hospital Infection Control, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310006, China; Microbiology Laboratory, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310001, China; Clinical Evaluation and Analysis Center, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310001, China; Department of Epidemiology and Health Statistics, School of Public Health, Zhejiang University, Hangzhou 310058, China; Department of Gastroenterology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310001, China
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15
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Dalager-Pedersen M, Thomsen RW, Schønheyder HC, Nielsen H. Functional status and quality of life after community-acquired bacteraemia: a matched cohort study. Clin Microbiol Infect 2015; 22:78.e1-78.e8. [PMID: 26384680 DOI: 10.1016/j.cmi.2015.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 09/04/2015] [Accepted: 09/07/2015] [Indexed: 10/23/2022]
Abstract
Severe bacterial infections may have a prolonged negative effect on subsequent functional status and health-related quality of life. We studied hospitalized patients for changes in functional status and quality of life within 1 year of community-acquired bacteraemia in comparison to blood-culture-negative controls. In a prospectively conducted matched cohort study at Aalborg University Hospital, north Denmark, during 2011-2014, we included 71 medical inpatients with first-time community-acquired bacteraemia. For each bacteraemia patient, we matched one blood-culture-negative inpatient control on age and gender. Functional status and quality of life before and after hospitalization were assessed by Barthel-20 and EuroQol-5D questionnaires. We computed the 3-month and 1-year risk for any deterioration in Barthel-20 score and EuroQol-5D index score, and for a deterioration of ≥10 points in EuroQol-5D visual analogue scale score, and used regression analyses to assess adjusted risk ratios (RR) with 95% CIs. Compared with controls, bacteraemia was associated with an increased 3-month risk for deterioration in functional status as assessed by Barthel-20 score (14% versus 3% with deterioration, adjusted RR 5.1; 95% CI 1.2-22.3). The difference was less after 1 year (11% versus 7% with deterioration, adjusted RR 1.6; 95% CI 0.5-4.5). After 3 months, quality of life had become worse in 37% of bacteraemia patients and 28% of controls by EuroQol-5D index score (adjusted RR 1.3; 95% CI 0.8-2.1), with similar findings after 1 year and by visual analogue scale. In conclusion, community-acquired bacteraemia is associated with increased risk for subsequent deterioration in functional status compared with blood-culture-negative controls, and with a high risk for deterioration in quality of life.
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Affiliation(s)
- M Dalager-Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - R W Thomsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - H C Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - H Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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16
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Gradel KO, Nielsen SL, Pedersen C, Knudsen JD, Østergaard C, Arpi M, Jensen TG, Kolmos HJ, Søgaard M, Lassen AT, Schønheyder HC. Low Completeness of Bacteraemia Registration in the Danish National Patient Registry. PLoS One 2015; 10:e0131682. [PMID: 26121584 PMCID: PMC4488274 DOI: 10.1371/journal.pone.0131682] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 06/04/2015] [Indexed: 12/18/2022] Open
Abstract
Bacteraemia is associated with significant morbidity and mortality and timely access to relia-ble information is essential for health care administrators. Therefore, we investigated the complete-ness of bacteraemia registration in the Danish National Patient Registry (DNPR) containing hospital discharge diagnoses and surgical procedures for all non-psychiatric patients. As gold standard we identified bacteraemia patients in three defined areas of Denmark (~2.3 million inhabitants) from 2000 through 2011 by use of blood culture data retrieved from electronic microbiology databases. Diagnoses coded according to the International Classification of Diseases, version 10, and surgical procedure codes were retrieved from the DNPR. The codes were categorized into seven groups, ranked a priori according to the likelihood of bacteraemia. Completeness was analysed by contin-gency tables, for all patients and subgroups. We identified 58,139 bacteraemic episodes in 48,450 patients; 37,740 episodes (64.9%) were covered by one or more discharge diagnoses within the sev-en diagnosis/surgery groups and 18,786 episodes (32.3%) had a code within the highest priority group. Completeness varied substantially according to speciality (from 17.9% for surgical to 36.4% for medical), place of acquisition (from 26.0% for nosocomial to 36.2% for community), and mi-croorganism (from 19.5% for anaerobic Gram-negative bacteria to 36.8% for haemolytic strepto-cocci). The completeness increased from 25.1% in 2000 to 35.1% in 2011. In conclusion, one third of the bacteraemic episodes did not have a relevant diagnosis in the Danish administrative registry recording all non-psychiatric contacts. This source of information should be used cautiously to iden-tify patients with bacteraemia.
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Affiliation(s)
- Kim Oren Gradel
- Center for Clinical Epidemiology, South, Odense University Hospital, Odense, Denmark
- Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- * E-mail:
| | - Stig Lønberg Nielsen
- Center for Clinical Epidemiology, South, Odense University Hospital, Odense, Denmark
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Court Pedersen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Jenny Dahl Knudsen
- Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | - Christian Østergaard
- Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre Hospital, Hvidovre, Denmark
| | - Magnus Arpi
- Department of Clinical Microbiology, Copenhagen University Hospital, Herlev Hospital, Herlev, Denmark
| | - Thøger Gorm Jensen
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Hans Jørn Kolmos
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Mette Søgaard
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Henrik Carl Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg Denmark
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17
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Søgaard M, Thomsen RW, Bang RB, Schønheyder HC, Nørgaard M. Trends in length of stay, mortality and readmission among patients with community-acquired bacteraemia. Clin Microbiol Infect 2015; 21:789.e1-7. [PMID: 26003278 DOI: 10.1016/j.cmi.2015.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 04/30/2015] [Accepted: 05/08/2015] [Indexed: 11/28/2022]
Abstract
In patients hospitalized with severe infection, premature discharge may lead to increased risk of readmission and death. We conducted this population-based cohort study to examine trends in length of stay (LOS) and 30-day mortality and hospital readmission rates after bacteraemia from 1994 through 2013. We used Cox regression to compute hazard ratios (HRs) for 30-day mortality and 30-day postdischarge readmission rates by calendar period and quintiles of LOS, adjusting for age, sex and comorbidity. Among 7618 patients hospitalized with community-acquired bacteraemia during the study period, median LOS decreased from 12 days (quartiles 7-21 days) in 1994-1998 to 9 days (quartiles 6-16 days) in 2009-2013 (25% relative reduction). The 30-day mortality fell from 16.7% to 15.0%, yielding an adjusted 30-day HR of 0.80 (95% confidence interval (CI) 0.68-0.95). Almost one fifth (19.4%) of patients discharged alive were readmitted within 30 days. Concurrently, the adjusted HR of readmission tended to increase (adjusted HR 1.09, 95% CI 0.93-1.28) in 2009-2013 compared with 1994-1998. Compared with the middle quintile of LOS (9-12 days), the risk of readmission was slightly higher for patients discharged within 5 days (adjusted HR 1.12, 95% CI 0.92-1.37), especially for readmission due to infection (adjusted HR 1.38, 95% CI 1.03-1.85). Readmission risk was lowest for 6 to 8 days LOS (adjusted HR 0.80, 95% CI 0.67-0.95) and highest for LOS ≥23 days (adjusted HR 1.30, 95% CI 1.11-1.53). The declining LOS after community-acquired bacteraemia between 1994 and 2013 was not accompanied by increased 30-day mortality but by slightly increased readmission rates.
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Affiliation(s)
- M Søgaard
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
| | - R W Thomsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - R B Bang
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - H C Schønheyder
- Department of Clinical Microbiology, Aalborg Hospital, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - M Nørgaard
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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18
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Søgaard KK, Thomsen RW, Schønheyder HC, Søgaard M. Positive predictive values of the International Classification of Diseases, 10th revision diagnoses of Gram-negative septicemia/sepsis and urosepsis for presence of Gram-negative bacteremia. Clin Epidemiol 2015; 7:195-9. [PMID: 25709502 PMCID: PMC4334314 DOI: 10.2147/clep.s75262] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Health care databases are a valuable resource for infectious disease epidemiology if diagnoses are accurately coded. We examined the ability of diagnostic coding to accurately identify Gram-negative bacteremia. Methods We randomly selected 100 patients among 1,703 patients recorded in the Danish National Patient Register with a diagnosis of either “septicemia/sepsis due to other Gram-negative organisms” (International Classification of Diseases, 10th revision [ICD-10] code A41.5) or “urosepsis” (ICD-10 code A41.9B) who had been admitted at Aalborg University Hospital, Denmark between 1994 and 2012. We estimated the positive predictive value (PPV) of these diagnoses for presence of Gram-negative bacteremia, using microbiological results from blood cultures as standard reference. Complementary clinical information was obtained from the medical records. Results Of the 100 patients registered with Gram-negative septicemia/sepsis or urosepsis, 72 had blood culture confirmed Gram-negative bacteremia, four patients had monomicrobial Gram-positive bacteremia, 21 patients had a negative blood culture, and three had no blood culture taken. The overall PPV of a blood culture confirmed Gram-negative bacteremia diagnosis was 72% (95% confidence interval [CI]: 62%–81%); for ICD-10 code A41.5 it was 86% (95% CI: 74%–94%) and for ICD-10 code A41.9B it was 55% (95% CI: 39%–70%). The highest PPV was achieved for diagnoses registered in the most recent calendar period (2009–2012) and for secondary discharge diagnoses. Conclusion Our findings indicated good agreement between ICD-10 code A41.5 “septicemia/sepsis due to other Gram-negative organisms” and Gram-negative bacteremia, whereas ICD-10 code A41.9B “urosepsis” was not suited for identification of Gram-negative bacteremia.
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Affiliation(s)
- Kirstine Kobberøe Søgaard
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Reimar Wernich Thomsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Carl Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark ; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Mette Søgaard
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Gradel KO, Schønheyder HC, Arpi M, Knudsen JD, Ostergaard C, Søgaard M. The Danish Collaborative Bacteraemia Network (DACOBAN) database. Clin Epidemiol 2014; 6:301-8. [PMID: 25258557 PMCID: PMC4172047 DOI: 10.2147/clep.s66998] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The Danish Collaborative Bacteraemia Network (DACOBAN) research database includes microbiological data obtained from positive blood cultures from a geographically and demographically well-defined population serviced by three clinical microbiology departments (1.7 million residents, 32% of the Danish population). The database also includes data on comorbidity from the Danish National Patient Registry, vital status from the Danish Civil Registration System, and clinical data on 31% of nonselected records in the database. Use of the unique civil registration number given to all Danish residents enables linkage to additional registries for specific research projects. The DACOBAN database is continuously updated, and it currently comprises 39,292 patients with 49,951 bacteremic episodes from 2000 through 2011. The database is part of an international network of population-based bacteremia registries from five developed countries on three continents. The main purpose of the DACOBAN database is to study surveillance, risk, and prognosis. Sex- and age-specific data on background populations enables the computation of incidence rates. In addition, the high number of patients facilitates studies of rare microorganisms. Thus far, studies on Staphylococcus aureus, enterococci, computer algorithms for the classification of bacteremic episodes, and prognosis and risk in relation to socioeconomic factors have been published.
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Affiliation(s)
- Kim Oren Gradel
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark ; Research Unit of Clinical Epidemiology, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Henrik Carl Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark ; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Magnus Arpi
- Department of Clinical Microbiology, Herlev Hospital, Copenhagen University Hospital, Herlev, Denmark
| | - Jenny Dahl Knudsen
- Department of Clinical Microbiology, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | - Christian Ostergaard
- Department of Clinical Microbiology, Hvidovre Hospital, Copenhagen University Hospital, Hvidovre, Denmark
| | - Mette Søgaard
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
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Dalager-Pedersen M, Søgaard M, Schønheyder HC, Nielsen H, Thomsen RW. Risk for Myocardial Infarction and Stroke After Community-Acquired Bacteremia. Circulation 2014; 129:1387-96. [DOI: 10.1161/circulationaha.113.006699] [Citation(s) in RCA: 105] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Infections may trigger acute cardiovascular events, but the risk after community-acquired bacteremia is unknown. We assessed the risk for acute myocardial infarction and ischemic stroke within 1 year of community-acquired bacteremia.
Methods and Results—
This population-based cohort study was conducted in Northern Denmark. We included 4389 hospitalized medical patients with positive blood cultures obtained on the day of admission. Patients hospitalized with bacteremia were matched with up to 10 general population controls and up to 5 acutely admitted nonbacteremic controls, matched on age, sex, and calendar time. All incident events of myocardial infarction and stroke during the following 365 days were ascertained from population-based healthcare databases. Multivariable regression analyses were used to assess relative risks with 95% confidence intervals (CIs) for myocardial infarction and stroke among bacteremia patients and their controls. The risk for myocardial infarction or stroke was greatly increased within 30 days of community-acquired bacteremia: 3.6% versus 0.2% among population controls (adjusted relative risk, 20.86; 95% CI, 15.38–28.29) and 1.7% among hospitalized controls (adjusted relative risk, 2.18; 95% CI, 1.80–2.65). The risks for myocardial infarction or stroke remained modestly increased from 31 to 180 days after bacteremia in comparison with population controls (adjusted hazard ratio, 1.64; 95% CI, 1.18–2.27), but not versus hospitalized controls (adjusted hazard ratio, 0.95; 95% CI, 0.69–1.32). No differences in cardiovascular risk were seen after >6 months. Increased 30-day risks were consistently found for a variety of etiologic agents and infectious foci.
Conclusions—
Community-acquired bacteremia is associated with increased short-term risk of myocardial infarction and stroke.
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Affiliation(s)
- Michael Dalager-Pedersen
- From the Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark (M.D.-P., H.N.); Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark (M.D.-P., M.S., R.W.T.); and Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark (H.C.S.)
| | - Mette Søgaard
- From the Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark (M.D.-P., H.N.); Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark (M.D.-P., M.S., R.W.T.); and Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark (H.C.S.)
| | - Henrik Carl Schønheyder
- From the Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark (M.D.-P., H.N.); Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark (M.D.-P., M.S., R.W.T.); and Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark (H.C.S.)
| | - Henrik Nielsen
- From the Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark (M.D.-P., H.N.); Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark (M.D.-P., M.S., R.W.T.); and Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark (H.C.S.)
| | - Reimar Wernich Thomsen
- From the Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark (M.D.-P., H.N.); Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark (M.D.-P., M.S., R.W.T.); and Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark (H.C.S.)
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Dalager-Pedersen M, Koch K, Wernich Thomsen R, Schønheyder HC, Nielsen H. The effect of community-acquired bacteraemia on return to workforce, risk of sick leave, permanent disability pension and death: a Danish population-based cohort study. BMJ Open 2014; 4:e004208. [PMID: 24477315 PMCID: PMC3913024 DOI: 10.1136/bmjopen-2013-004208] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES Little is known about the prognosis of community-acquired bacteraemia (CAB) in workforce adults. We assessed return to workforce, risk for sick leave, disability pension and mortality within 1 year after CAB in workforce adults compared with blood culture-negative controls and population controls. DESIGN Population-based cohort study. SETTING North Denmark, 1996-2011. PARTICIPANTS We used population-based healthcare registries to identify all patients aged 20-58 years who had first-time blood cultures obtained within 48 h of medical hospital admission, and who were part of the workforce (450 bacteraemia exposed patients and 6936 culture-negative control patients). For each bacteraemia patient, we included up to 10 matched population controls. PRIMARY AND SECONDARY OUTCOME MEASURES Return to workforce, risk of sick leave, permanent disability pension and mortality within 1 year after bacteraemia. Regression analyses were used to compute adjusted relative risks (RRs) with 95% CIs. RESULTS One year after admission, 78% of patients with CAB, 85.7% of culture-negative controls and 96.8% of population controls were alive and in the workforce, and free from sick leave or disability pension. Compared with culture-negative controls, bacteraemia was associated with an increased risk for long-term sick leave (4-week duration, 40.2% vs 23.9%, adjusted RR, 1.51; CI 1.34 to 1.70) and an increased risk for mortality (30-day mortality, 4% vs 1.4%, adjusted RR, 2.34, CI 1.22 to 4.50; 1-year mortality, 8% vs 3.9%, adjusted RR, 1.73; CI 1.18 to 2.55). Bacteraemia patients had a risk for disability pension similar to culture-negative controls (2.7% vs 2.6%, adjusted RR, 0.99, CI 0.48 to 2.02) but greater than population controls (adjusted RR, 5.20; 95% CI 2.16 to 12.50). CONCLUSIONS CAB is associated with long duration of sick leave and considerable mortality in working-age adults when compared with blood culture-negative controls, and an increased 1-year risk for disability pension when compared with population controls.
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Affiliation(s)
- Michael Dalager-Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Kristoffer Koch
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | - Reimar Wernich Thomsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | | | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
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Dalager-Pedersen M, Søgaard M, Schønheyder HC, Thomsen RW, Baron JA, Nielsen H. Venous thromboembolism after community-acquired bacteraemia: a 20-year danish cohort study. PLoS One 2014; 9:e86094. [PMID: 24465892 PMCID: PMC3900448 DOI: 10.1371/journal.pone.0086094] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 12/09/2013] [Indexed: 11/23/2022] Open
Abstract
Background Infections may increase the risk for venous thromboembolism (VTE), but little is known about VTE risk associated with community-acquired bacteraemia (CAB). We examined the risk for VTE within one year of CAB in comparison to that in matched controls. Methods We conducted a population-based cohort study in North Denmark 1992–2011, using data from high-quality health-care databases. We included 4,213 adult CAB patients who had positive blood cultures drawn on the day of hospital admission, 20,084 matched hospitalised controls admitted for other acute medical illness, and 41,121 matched controls from the general population. We computed 0–90 and 91–365 day absolute risks for hospital-diagnosed VTE and used regression analyses with adjustment for confounding factors to compare the risk for VTE in bacteraemia patients and controls. Results Among CAB patients, 1.1% experienced VTE within 90 days of admission and 0.5% during 91–365 days after admission. The adjusted 90-day odds ratio (OR) for VTE was 1.9 (95% CI 1.4–2.7) compared with hospitalised controls, and 23.4 (95% CI 12.9–42.6) compared with population controls. During 91–365 days after CAB admission, the VTE risk remained moderately increased (adjusted hazard ratio vs. hospitalised controls, 1.4; 95% CI 0.8–2.5, and vs. population controls, 1.9; 95% CI 1.0–3.3). Compared to hospitalised controls, the 90-day VTE risk increase was greater for Gram-positive infection (adjusted OR 2.5; 95% CI 1.6–4.1) than for Gram-negative infection (adjusted OR, 1.2; 95% CI 0.7–2.1), partly due to a high risk after Staphylococcus aureus infection (3.6%). Conclusion The risk for VTE is substantially increased within 90 days after community-acquired bacteraemia when compared to hospitalised controls and population controls. However, the absolute risk of VTE following CAB is low.
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Affiliation(s)
- Michael Dalager-Pedersen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
| | - Mette Søgaard
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Reimar W. Thomsen
- Department of Clinical Epidemiology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - John A. Baron
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
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Gradel KO, Jensen TG, Kolmos HJ, Pedersen C, Vinholt PJ, Lassen AT. Does C-reactive protein independently predict mortality in adult community-acquired bacteremia patients with known sepsis severity? APMIS 2012; 121:835-42. [PMID: 23278429 DOI: 10.1111/apm.12040] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 11/14/2012] [Indexed: 11/30/2022]
Abstract
We evaluated whether sepsis severity and C-reactive protein (CRP) level on admission prognostically corroborated or annulled each other in adult patients with incident community-acquired bacteremia (Funen, Denmark, 2000-2008). We used logistic regression and area under the receiver operating characteristic curve (AUC) to evaluate 30-day mortality in four models: (i) age, gender, comorbidity, bacteria, and ward. (ii) Model 1 and sepsis severity. (iii) Model 1 and CRP. (iv) Model 1, sepsis severity, and CRP. Altogether, 416 of 1999 patients died within 30 days. CRP independently predicted 30-day mortality [Model 4, odds ratio (95% CIs) for 100 mg/L: 1.16 (1.06-1.27)], but it did not contribute to the AUC (Model 2 vs Model 4: p = 0.31). In the 963 non-severe sepsis patients, CRP independently predicted 30-day mortality [Model 4: 1.42 (1.20-1.69)] and it increased the AUC (Model 2 vs Model 4: p = 0.06), thus CRP contributed as much as sepsis severity to prognosis.
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Affiliation(s)
- Kim O Gradel
- Research Unit of Clinical Epidemiology, Centre for National Clinical Databases, South, Odense University Hospital, Odense, Denmark.
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Cortelli JR, Cogo K, Aquino DR, Cortelli SC, Ricci-Nittel D, Zhang P, Araujo MWBD. Validation of the anti-bacteremic efficacy of an essential oil rinse in a Brazilian population: a cross-over study. Braz Oral Res 2012; 26:478-84. [DOI: 10.1590/s1806-83242012005000021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 06/12/2012] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | | | | | - Paul Zhang
- Johnson & Johnson Consumer & Personal Products Worldwide, USA
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Pedersen AB, Mehnert F, Odgaard A, Schrøder HM. Existing data sources for clinical epidemiology: The Danish Knee Arthroplasty Register. Clin Epidemiol 2012; 4:125-35. [PMID: 22701092 PMCID: PMC3372970 DOI: 10.2147/clep.s30050] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose We described the settings, organization, content, and data quality of the Danish Knee Arthroplasty Register (DKR), as well as the incidence and the first results of the knee replacement procedures captured by the DKR. Our aim was to draw researchers’ attention to the DKR and its potential use in clinical epidemiological research. Patients and methods The DKR has collected data on all knee replacement procedures performed in Denmark since 1997. The validity of the register was compared with the Danish National Registry of Patients (DNRP). Incidence rate was calculated per 100,000 inhabitants. Implant survival was estimated by Kaplan–Meier method. Cox regression analyses were used to estimate the relative risk (RR) for revision with a 95% confidence interval (CI). Results A total of 62,586 primary knee arthroplasties and 6,683 revisions were registered in the DKR between January 1, 1997 and December 31, 2010. More than 90% of the private and public hospitals performing knee replacement surgery in Denmark have entered data to the DKR. Registration completeness of primary procedures and revisions has increased since the DKR initiation and was 88% in 2010 for both procedures, compared with registration in the DNRP. For primary knee arthroplasties, the annual incidence rate increased from 35.8 in 1997 to 155.2 in 2010 per 100,000 inhabitants. Incidence was higher in females than in males during the entire study period, and increased with age for both sexes. The overall implant survival after 14 years was 89% irrespective of diagnosis for surgery. Male patients had higher revision risk than females, and revision risk decreased with increasing age. Risk for any revision was higher for uncemented implants (RR = 1.48; 95% CI: 1.32–1.66), and lower for hybrid implants (RR = 0.84; 95% CI: 0.75–0.95) compared to cemented implants. Implant survival did not improve but remained the same throughout the study period when comparing patients operated in the periods 1997–2000 versus 2001–2003, 2004–2006, and 2007–2010. Conclusion The DKR is a valuable tool for quality monitoring and research in knee arthroplasty surgery due to the high quality and completeness of prospective, routinely collected data. Large population-based epidemiological studies can be performed in order to study trends as well as risk factors for poor clinical outcome following knee arthroplasty surgery.
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Affiliation(s)
- Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus
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Olsen RH, Schønheyder HC, Christensen H, Bisgaard M. Enterococcus faecalis of human and poultry origin share virulence genes supporting the zoonotic potential of E. faecalis. Zoonoses Public Health 2011; 59:256-63. [PMID: 22122842 DOI: 10.1111/j.1863-2378.2011.01442.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Enterococcus faecalis is a major cause of nosocomial infections in humans and has been linked to severe extra-intestinal infections in poultry. A zoonotic potential has been suggested and the aim of the present study was to investigate similarities in virulence gene profiles of E. faecalis originating from infections in humans and poultry respectively. A total of 106 isolates of E. faecalis [26 human clinical isolates, 60 poultry clinical isolates (including two small-colony variants (SCVs) and 20 poultry cloacal isolates] were investigated for presence of seven virulence-associated genes: ace, asa1, cylA, efaA, EF0591, esp and gelE. For each gene, the PCR-amplification product was sequenced from one isolate in each group to explore intragenic variations between genes of human and poultry origin. Haemolytic and protease activities were assessed and isolates were assigned a sequence type (ST). Three of the seven genes investigated (ace, efaA and gelE) were present in all isolates. The asa1 was detected in 63/80 and 13/26 isolates of poultry and human origin respectively. For cylA, the numbers were 46/80 and 14/26 respectively. Among poultry isolates, esp and EF0591 were the least frequently observed genes (1/80 and 20/80 respectively); the prevalences among human isolates were 1/26 and 18/26 respectively. A high degree of similarity between genes in human and poultry isolates were confirmed by sequencing of amplification products. None of the cylA-positive isolates demonstrated haemolytic activity, while the phenotypic expression of gelatinase varied. The ST16 was the only ST shared by human and poultry isolates. The SCV isolates did not show a unique virulence profile or phylogeny. In conclusion, regardless of the distinct phylogenetic background of most E. faecalis isolates of human and poultry origin, we found major similarities in virulence gene profile and gene sequences in isolates from the two sources, supporting the zoonotic risk associated with this organism.
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Affiliation(s)
- R H Olsen
- Department of Veterinary Disease Biology, Faculty of Life Sciences, University of Copenhagen, Frederiksberg C, Denmark.
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Impact of diabetes and poor glycaemic control on risk of bacteraemia with haemolytic streptococci groups A, B, and G. J Infect 2011; 63:8-16. [DOI: 10.1016/j.jinf.2011.05.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Revised: 05/18/2011] [Accepted: 05/18/2011] [Indexed: 01/13/2023]
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Laupland KB, Svenson LW, Gregson DB, Church DL. Long-term mortality associated with community-onset bloodstream infection. Infection 2011; 39:405-10. [DOI: 10.1007/s15010-011-0149-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 06/09/2011] [Indexed: 11/25/2022]
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Søgaard M, Nørgaard M, Pedersen L, Sørensen HT, Schønheyder HC. Blood culture status and mortality among patients with suspected community-acquired bacteremia: a population-based cohort study. BMC Infect Dis 2011; 11:139. [PMID: 21599971 PMCID: PMC3128048 DOI: 10.1186/1471-2334-11-139] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Accepted: 05/20/2011] [Indexed: 11/25/2022] Open
Abstract
Background Comparison of mortality among patients with positive and negative blood cultures may indicate the contribution of bacteremia to mortality. This study (1) compared mortality among patients with community-acquired bacteremia with mortality among patients with negative blood cultures and (2) determined the effects of bacteremia type and comorbidity level on mortality among patients with positive blood cultures. Methods This cohort study included 29,273 adults with blood cultures performed within the first 2 days following hospital admission to an internal medical ward in northern Denmark during 1995-2006. We computed product limit estimates and used Cox regression to compute adjusted mortality rate ratios (MRRs) within 0-2, 3-7, 8-30, and 31-180 days following admission for bacteremia patients compared to culture-negative patients. Results Mortality in 2,648 bacteremic patients and 26,625 culture-negative patients was 4.8% vs. 2.0% 0-2 days after admission, 3.7% vs. 2.7% 3-7 days after admission, 5.6% vs. 5.1% 8-30 days after admission, and 9.7% vs. 8.7% 31-180 days after admission, corresponding to adjusted MRRs of 1.9 (95% confidence interval (CI): 1.6-2.2), 1.1 (95% CI: 0.9-1.5), 0.9 (95% CI: 0.8-1.1), and 1.0 (95% CI: 0.8-1.1), respectively. Mortality was higher among patients with Gram-positive (adjusted 0-2-day MRR 1.9, 95% CI: 1.6-2.2) and polymicrobial bacteremia (adjusted 0-2-day MRR 3.5, 95% CI: 2.2-5.5) than among patients with Gram-negative bacteremia (adjusted 0-2-day MRR 1.5, 95% CI 1.2-2.0). After the first 2 days, patients with Gram-negative bacteremia had the same risk of dying as culture-negative patients (adjusted MRR 0.8, 95% CI: 0.5-1.1). Only patients with polymicrobial bacteremia had increased mortality within 31-180 days following admission (adjusted MRR 1.3, 95% CI: 0.8-2.1) compared to culture-negative patients. The association between blood culture status and mortality did not differ substantially by level of comorbidity. Conclusions Community-acquired bacteremia was associated with an increased risk of mortality in the first week of medical ward admission. Higher mortality among patients with Gram-positive and polymicrobial bacteremia compared with patients with Gram-negative bacteremia and negative cultures emphasizes the prognostic importance of these infections.
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Affiliation(s)
- Mette Søgaard
- Department of Clinical Microbiology, Aalborg Hospital, Aarhus University Hospital, Denmark.
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Grann AF, Erichsen R, Nielsen AG, Frøslev T, Thomsen RW. Existing data sources for clinical epidemiology: The clinical laboratory information system (LABKA) research database at Aarhus University, Denmark. Clin Epidemiol 2011; 3:133-8. [PMID: 21487452 PMCID: PMC3072155 DOI: 10.2147/clep.s17901] [Citation(s) in RCA: 161] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Indexed: 11/23/2022] Open
Abstract
This paper provides an introduction to the clinical laboratory information system (LABKA) research database in Northern and Central Denmark. The database contains millions of stored laboratory test results for patients living in the two Danish regions, encompassing 1.8 million residents, or one-third of the country’s population. More than 1700 different types of blood test analyses are available. Therefore, the LABKA research database represents an incredible source for studies involving blood test analyses. By record linkage of different Danish registries with the LABKA research database, it is possible to examine a large number of biomarkers as predictors of disease risk and prognosis and as markers of disease severity, and to evaluate medical treatments regarding effectiveness and possible side effects. Large epidemiological studies using routinely stored blood test results for individual patients can be performed because it is possible to link the laboratory data to high-quality individual clinical patient data in Denmark.
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Affiliation(s)
- Anne Fia Grann
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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LARSEN INGEKRISTINE, PEDERSEN GITTE, SCHØNHEYDER HENRIKC. Bacteraemia with an unknown focus: is the focus de facto absent or merely unreported? A one-year hospital-based cohort study. APMIS 2011; 119:275-9. [DOI: 10.1111/j.1600-0463.2011.02727.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Sogaard M, Norgaard M, Dethlefsen C, Schonheyder HC. Temporal Changes in the Incidence and 30-Day Mortality associated with Bacteremia in Hospitalized Patients from 1992 through 2006: A Population-based Cohort Study. Clin Infect Dis 2011; 52:61-9. [DOI: 10.1093/cid/ciq069] [Citation(s) in RCA: 122] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Epidemiology of Haemophilus influenzae bacteremia: a multi-national population-based assessment. J Infect 2010; 62:142-8. [PMID: 21094183 DOI: 10.1016/j.jinf.2010.11.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2010] [Revised: 11/09/2010] [Accepted: 11/12/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Haemophilus influenzae is an important cause of invasive infection but contemporary data in non-selected populations is limited. METHODS Population-based surveillance for Haemophilus influenzae bacteremia was conducted in seven regions in Australia, Canada, and Denmark during 2000-2008. RESULTS The overall annual incidence rate was 1.31 per 100,000 population and type specific rates were 0.08 for H. influenzae serotype b (Hib), 0.22 for H. influenzae serotypes a, c-f (Hiac-f), and 0.98 per 100,000 for non-typeable H. influenzae (NTHi). Very young and old patients were at highest risk. The serotypes causing disease varied according to age with nearly all cases in the elderly due to NTHi. The presence of comorbid medical illness was common with 14%, 16%, and 29% patients having Charlson comorbidity scores of 1, 2, and ≥ 3, respectively. The 30-day all-cause case-fatality rate was 18%. Factors independently associated with death at 30-days in logistic regression analysis included male gender, hospital-onset disease, older age, and lower respiratory tract, central nervous system, or unknown focus of infection. CONCLUSIONS Haemophilus influenzae is an important cause of morbidity and mortality particularly with NTHi in the elderly. These data serve as a baseline to assess the future effectiveness of new preventative interventions.
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Changes in blood culture methodology have an impact on time trends of bacteraemia: a 26-year regional study. Epidemiol Infect 2010; 139:772-6. [DOI: 10.1017/s095026881000169x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARYThe incidence of bacteraemia has increased considerably during the last decades. This may be related to population ageing, increased use of invasive procedures, and increased ascertainment of bacteraemia. Generalized additive and generalized linear models were used to analyse the impact of four successive improvements in blood culture methodology on the recovery of prevalent blood culture isolates while simultaneously controlling for underlying time trend and seasonal variation. Between 1981 and 2006, 20 091 bacteraemias comprising 22 800 blood culture isolates were diagnosed. The changes in methodology increased the recovery of some bacterial groups; the greatest impact was observed for Enterobacteriaceae, pneumococci andStaphylococcus aureuswhereas recovery of β-haemolytic streptococci,Pseudomonas aeruginosa, other Gram-negative aerobes, and fungi was not affected. Changes in blood culture methodology should be taken into account when assessing time trends of bacteraemia.
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