Browsing by Subject "infection"
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Item Assessment of postoperative outcomes in spinal epidural abscess following surgical decompression(Elsevier, 2019) Keller, Leonard J.; Alentado, Vincent J.; Tanenbaum, Joseph E.; Lee, Bryan S.; Nowacki, Amy S.; Benzel, Edward C.; Mroz, Thomas E.; Steinmetz, Michael P.; Neurological Surgery, School of MedicineBackground context A spinal epidural abscess (SEA) is a serious condition that may be managed with antibiotics alone or with decompressive surgery combined with antibiotics. Purpose The objectives of this study were to assess the clinical outcomes of SEA after surgical management and to identify the patient-level factors that are associated with outcomes following surgical decompression and removal of SEA. Study design/setting Retrospective chart review analysis. Patient sample An analysis of 154 consecutive patients who initially presented to a tertiary-care, academic medical center with SEA, and were subsequently treated with surgery between 2010 and 2015 was performed. Outcome measures Postoperative predischarge American Spinal Injury Association Impairment Scale (AIS) scores, 6-month follow-up encounter AIS scores, need for revision surgery, and mortality during SEA surgery were the primary outcomes.Physiological Measures: AIS scores. Method Fisher's exact and Wilcoxon rank-sum tests were used to assess the associations between patient-level factors and surgical outcomes. Moreover, an interactive, predictive model for postoperative predischarge AIS score was developed using a proportional odds regression model. There was no funding secured for this study and there is no conflict of interest-associated biases. Results One hundred fifty-four patients (mean age of 58 years) were treated using surgical decompression in addition to antibiotics. The majority of patients were Caucasian (81%) and male (61%). No intraoperative mortality was reported. A second SEA surgery was performed in 8% of patients. A comparison of the preoperative and postoperative predischarge AIS scores showed that 49% of patients maintained a score of E or improved, while 45% remained at their preoperative status and 6% worsened. Among a subset of patients (n=36; 23%) for whom a 6-month follow-up encounter occurred, 75% maintained an AIS score of E or improved, 19% remained at their preoperative status, and 6% worsened. Both the presence and longer duration of preoperative paresis was associated with an increased risk of remaining at the same AIS score or worsening at the predischarge encounter (both p< .001). A predictive model for predischarge AIS scores was developed based on several patient characteristics. Conclusions Surgical decompression can contribute to improving or maintaining AIS scores in a high percentage of SEA patients. The presence and duration of preoperative paresis are prognostic for poorer outcomes and suggest that rapid surgical intervention before paresis develops may lead to improved postoperative outcomes. Our modeling tool enables an estimation of probabilities of patients’ predischarge condition.Item Cryopreserved Homografts in Infected Infrainguinal Fields Are Associated with Frequent Reinterventions and Poor Amputation-Free Survival(Elsevier, 2018) Wang, S. Keisin; Gutwein, Ashley R.; Drucker, Natalie A.; Murphy, Michael P.; Fajardo, Andres; Dalsing, Michael C.; Motaganahalli, Raghu L.; Lemmon, Gary W.; Surgery, School of MedicineBackground Single-length saphenous vein continues to be the conduit of choice in infected-field critical limb ischemia. However, half of these individuals have inadequate vein secondary to previous use or chronic venous disease. We reviewed our outcomes of infected-field infrainguinal bypasses performed with cryopreserved homografts (CHs), a widely accepted alternative to autogenous vein in this setting. Methods This is a retrospective, institutional descriptive analysis of infected-field infrainguinal revascularizations between 2012 and 2015. Results Twenty-four operations were performed in the same number of patients for limb ischemia with signs of active infection. The mean age of the cohort examined was 62.5 ± 14.4 (standard deviation) years. Mean Society of Vascular Surgery risk score was 3.9 with a baseline Rutherford's chronic ischemia score of 4.3 at presentation. Emergent procedures constituted 29% of cases, and the remainder cases were urgent procedures. The CH bypass captured was a reoperative procedure in all but one of the patients. Culture positivity was present in 75% of cases with Staphylococcus aureus (29%), the most commonly isolated organism. Thirty-day mortality and major adverse cardiovascular events were both 4%. Amputation-free survival (AFS) was 75% at 30 days. Similarly, 30-day reintervention was 38% with debridement (43%) and bleeding (29%), the most common indications. Average duration of follow-up was 27.9 ± 20.4 months (range: 0.5–60.4). Mean length of stay was 14.8 days. Reinfection requiring an additional procedure or antibiotic regimen separate from the index antibiotic course was 13%. Primary patency and AFS at 1 year was 50% and 58%, respectively. Primary patency and AFS at 2 years was 38% and 52%, respectively. Limb salvage at 1 and 2 years was 70% and 65%, respectively. Fifteen patients (63%) required reintervention during the follow-up period with 40% of those subjects undergoing multiple procedures. Conclusions CHs remain a marginal salvage conduit in the setting of infection and no autogenous choices. Therefore, clinicians should individualize usage of this high-cost product in highly selected patients only.Item Deworming Program In Low-Income Nicaraguan School(2020-04-24) Collins, Angela J.Infection of soil-transmitted helminths (STH), commonly referred to as intestinal worms, are estimated to plague over 1.5 billion of the world’s most impoverished communities. Developing countries bear the largest burden of STH infections due to lack of access to clean water, safe housing, sanitation infrastructure, education and healthcare. In 2017, the director of the World Health Organization’s Neglected Tropical Diseases department, stated, “There is now global consensus that periodic, large-scale deworming is the best way to reduce the suffering caused by intestinal worms,” [1]. In addition, numerous studies have shown significant efficacy particularly among school-based deworming interventions. Therefore, in order to best steward the health and wellbeing of their students, as well as to comply with the World Health Organization’s recommendations, the Granada Christian Education Center (GCEC) ― a primary school located in one of the poorest areas of Nicaragua ― is requesting $1000 in funding to establish a school-based deworming program among their growing student body.Item High Failure Rates of Concomitant Periprosthetic Joint Infection and Extensor Mechanism Disruption(Elsevier, 2018) Anderson, Lucas A.; Culp, Brian M.; Della Valle, Craig J.; Gililland, Jeremy M.; Meneghini, R. Michael; Browne, James A.; Springer, Bryan D.; Orthopaedic Surgery, School of MedicineBackground Patients presenting with both chronic periprosthetic joint infection (PJI) and extensor mechanism disruption (EMD) pose a significant challenge. As there is little in the literature regarding outcomes of patients with concomitant PJI and EMD, we performed a multicenter study to evaluate the outcomes. Methods Sixty patients with concomitant diagnoses of PJI and EMD were evaluated from 5 institutions. Patient demographics, presentation type, surgical management, and outcomes including recurrent infections, final surgery, and ambulatory status were documented. Results Fifty-three of 60 patients had an attempted extensor mechanism reconstruction/repair (EMR) of which 12 (23%) were successful, averaging 3.5 (range, 2-7) intervening surgeries. Forty-one patients (77%) were considered failures with recurrence of infection as most common failure (80%); 26 ended in fusion, 10 in above knee amputation, 3 with chronic resection arthroplasty, and 2 with chronic spacers/EMD. Seven patients had no attempt at EMR but proceeded directly to fusion (n = 6) or amputation (n = 1). There was no statistical difference between groups that had success or failure of EMR in age, American Society of Anesthesiologists Physical Status Classification System, or body mass index. Conclusion Our study demonstrates that concomitant EMD and PJI is a dreaded combination with poor outcomes regardless of treatment. Eradication of infection and reconstruction of the extensor mechanism often require numerous surgeries and despite great effort often end in failure. Consideration of early fusion or amputation may be preferable in some patients to avoid the morbidity and mortality of repeated surgeries.Item Incidence and Outcomes Associated With Infections Caused by Vancomycin-Resistant Enterococci in the United States: Systematic Literature Review and Meta-Analysis(Cambridge, 2017-02) Chiang, Hsiu-Yin; Perencevich, Eli N.; Nair, Rajeshwari; Nelson, Richard E.; Samore, Matthew; Khader, Karim; Chorazy, Margaret L.; Herwaldt, Loreen A.; Blevins, Amy E.; Ward, Melissa A.; Schweizer, Marin L.; Department of Medicine, School of MedicineInformation about the health and economic impact of infections caused by vancomycin-resistant enterococci (VRE) can inform investments in infection prevention and development of novel therapeutics. To systematically review the incidence of VRE infection in the United States and the clinical and economic outcomes. We searched various databases for US studies published from January 1, 2000, through June 8, 2015, that evaluated incidence, mortality, length of stay, discharge to a long-term care facility, readmission, recurrence, or costs attributable to VRE infections. We included multicenter studies that evaluated incidence and single-center and multicenter studies that evaluated outcomes. We kept studies that did not have a denominator or uninfected controls only if they assessed postinfection length of stay, costs, or recurrence. We performed meta-analysis to pool the mortality data. Five studies provided incidence data and 13 studies evaluated outcomes or costs. The incidence of VRE infections increased in Atlanta and Detroit but did not increase in national samples. Compared with uninfected controls, VRE infection was associated with increased mortality (pooled odds ratio, 2.55), longer length of stay (3-4.6 days longer or 1.4 times longer), increased risk of discharge to a long-term care facility (2.8- to 6.5-fold) or readmission (2.9-fold), and higher costs ($9,949 higher or 1.6-fold more). VRE infection is associated with large attributable burdens, including excess mortality, prolonged in-hospital stay, and increased treatment costs. Multicenter studies that use suitable controls and adjust for time at risk or confounders are needed to estimate the burden of VRE infections.Item Infectious Complications of Ventricular Assist Device Use in Children in the US: Data from the Pediatric Interagency Registry for Mechanical Circulatory Support (Pedimacs)(Elsevier, 2017) Auerbach, Scott R.; Richmond, Marc E.; Schumacher, Kurt R.; Lopez-Colon, Dalia; Mitchell, Max B.; Turrentine, M. W.; Cantor, Ryan S.; Niebler, Robert A.; Eghtesady, Pirooz; Surgery, School of MedicineBackground Infections are frequent in pediatric ventricular assist device (VAD) patients. In this study we aimed to describe infections in durable VAD patients reported to Pedimacs. Methods Durable VAD data from the Pedimacs registry (September 19, 2012 to December 31, 2015) were analyzed. Infections were described with standard descriptive statistics, Kaplan–Meier analysis and competing outcomes analysis. Results There were 248 implants in 222 patients, with a mean age and a median follow-up of 11 ± 6.4 years and 2.4 patient-months (<1 day to 2.6 years), respectively. Device types were pulsatile flow (PF) in 91 (41%) patients and continuous flow (CF) in 131 (59%) patients. PF patients were younger (4 ± 4 vs 14 ± 4 years; p < 0.0001) and were more likely to have congenital heart disease (25% vs 12%; p = 0.03), prior surgery (53% vs 26%; p < 0.0001) and prior extracorporeal membrane oxygenation (24% vs 7%; p = 0.0003). Infection accounted for 17% (96 of 564) of the reported adverse events (AEs). A non-device infection was most common (51%), followed by sepsis (24%), external pump component infection (20%) and internal pump component infection (5%). Most infections were bacterial (73%) and required intravenous therapy only (77%). The risk of infection in the constant phase was higher in patients with a history of prior infection and in patients with a history of a non-infectious major AEs. Survival was lower after infection only in CF patients (p = 0.008). Conclusions Infection was the most common AE after pediatric VAD implantation. Non-device infections were most common. The best predictor of a future infection was a past infection. CF patients have higher risk of death after an infection.Item Iron Administration, Infection, and Anemia Management in CKD: Untangling the Effects of Intravenous Iron Therapy on Immunity and Infection Risk(Elsevier, 2020-03-27) Ganz, Tomas; Aronoff, George R.; Gaillard, Carlo A. J. M.; Goodnough, Lawrence T.; Macdougall, Iain C.; Mayer, Gert; Porto, Graça; Winkelmayer, Wolfgang C.; Wish, Jay B.; Medicine, School of Medicinedysfunction, increased exposure to infectious agents, loss of cutaneous barriers, comorbid conditions, and treatment-related factors (eg, hemodialysis and immunosuppressant therapy). Because iron plays a vital role in pathogen reproduction and host immunity, it is biologically plausible that intravenous iron therapy and/or iron deficiency influence infection risk in CKD. Available data from preclinical experiments, observational studies, and randomized controlled trials are summarized to explore the interplay between intravenous iron and infection risk among patients with CKD, particularly those receiving maintenance hemodialysis. The current evidence base, including data from a recent randomized controlled trial, suggests that proactive judicious use of intravenous iron (in a manner that minimizes the accumulation of non–transferrin-bound iron) beneficially replaces iron stores while avoiding a clinically relevant effect on infection risk. In the absence of an urgent clinical need, intravenous iron therapy should be avoided in patients with active infection. Although serum ferritin concentration and transferrin saturation can help guide clinical decision making about intravenous iron therapy, definition of an optimal iron status and its precise determination in individual patients remain clinically challenging in CKD and warrant additional study.Item The IUPUI Center for HPV Research: Updates 2014-2015(Office of the Vice Chancellor for Research, 2015-04-17) Zimet, Gregory D.; Fortenberry, J. DennisBackground: Human papillomavirus (HPV) is a very common infection. High risk (HR) HPV types (particularly types 16 & 18) are causally implicated in many cancers, including cervical, anal, vaginal, vulvar, penile, and head and neck cancers. In an effort to address the problems associated with HPV infection and prevention, the Center for HPV Research at IUPUI (Zimet & Fortenberry, Co-Directors) fosters collaboration among investigators from multiple disciplines and departments at IUPUI, IU Bloomington, Purdue University, and University of Notre Dame. There currently are 32 faculty and 8 pre- and post-doctoral fellows who are members of the Center. The Center for HPV Research was established in July, 2012 with funds from the IUPUI Signature Center Initiative, the Department of Pediatrics, and the IU Simon Cancer Center. Over the past year, Center members had 6 external & internal grants funded, 5 additional grants submitted, 8 peer-reviewed articles published, and gave over 20 scientific conference and invited presentations. In this abstract we highlight a study representing a collaboration among 5 center members, with Dr. Marcia Shew as the lead and including an MPH student. Objectives: Most HR HPV infections do not progress to cancer, but progression is associated with persistent infection. HPV was previously thought to "clear" or persist, but newer studies suggest that HPV may be a latent virus that can be re-detected episodically. This study examined the persistence and/or redetection of HR HPV in young women recruited 6 years after identification of a HR HPV infection during their prior involvement in a longitudinal study of adolescent women. Methods: 30 women from the prior study (the Young Women’s Project) were recruited for 2 visits, 6 weeks apart. During Visit 1 they had a Pap test, HPV DNA testing, HPV serology, and were administered a semi-structured interview. During Visit 2, Pap test results were given, a self-swab for HPV testing was obtained, and a qualitative interview was administered. Results: 15 women had normal Pap test results, 2 were ASCUS, and 3 LGSIL. 12 women had a history of colposcopy for a previous abnormal Pap results and 4 had received treatment for cervical dysplasia. 26 of the women had HPV 16 in the original YWP study. 11 had HPV 16 redetected in the present study, including in 6 women who had apparently "cleared" the infection during the original YWP study. Conclusions: High risk HPV may not always (or ever) "clear" Persistent low viral levels may not be detectible. However, some HPV infections may be episodically detected if changes in immune function lead to increases in viral copies. Questions raised by this research include: 1) who is at risk for episodic detection?; 2) what factors are predictive of episodic detection?; 3) how likely is episodically-detect HR HPV to progress to cervical disease?; 4) what is the predictive value of a negative HPV DNA test?; and 5) what do we tell women with a positive HR HPV DNA screen if they have been sexually abstinent or with a life-long partner ... or if they have a new partner?Item One Year Incidence of Infection in Pediatric Intestine Transplantation(Wolters Kluwer, 2018-05) Clouse, Jared W.; Kubal, Chandrashekhar A.; Fridell, Jonathan A.; Mangus, Richard S.; Surgery, School of MedicineBackground: This study reports the infection rate, location of infection, and pathogen causing bacterial, fungal, or viral infections in intestine transplant recipients at a pediatric transplant center. Methods: Records from a pediatric center were reviewed for patients receiving an intestine transplant. Positive cultures and pathology reports were used to diagnose bacterial, fungal, and viral infections and also to determine location and infectious agent. Risk for infection was assessed based on liver or colon inclusion, and immunosuppression induction, as part of the intestine transplant. Results: During the study period 52 intestine transplants were performed on 46 patients. Bacterial, fungal, and viral infection rates were 90%, 25%, and 75%, respectively. Enterococcus (non-vancomycin resistant enterococci (VRE)) species were the most common pathogens and were isolated from 52% of patients. VRE was present in 12% of transplant recipients. Candida species were the most common fungal pathogens (23% of patients). Respiratory viral infections were common (44%) and cytomegalovirus infection rate was 17%. Common sites of infection were bloodstream, urinary, and upper respiratory tract. Colon and liver inclusion in the transplant graft was not associated with increased risk of infection, nor was addition of rituximab to the immunosuppression induction protocol. Conclusion: Post-intestine transplant infections are ubiquitious in the pediatric population, including high rates of infection from bacterial, viral and fungal sources. Inclusion of the liver and/or colon as a component of the transplant graft did not appear to greatly impact the infectious risk. Adding rituximab to the immunosuppression induction protocol did not impact on infectious risk.Item Risk for Clostridium difficile Infection after Radical Cystectomy for Bladder Cancer: Analysis of a Contemporary Series(Elsevier, 2015-12) Liu, Nick W.; Shatagopam, Kashyap; Monn, M. Francesca; Kaimakliotis, Hristos Z.; Cary, Clint; Boris, Ronald S.; Mellon, Matthew J.; Masterson, Timothy A.; Foster, Richard S.; Gardner, Thomas A.; Bihrle, Richard; House, Michael G.; Koch, Michael O.; Department of Urology, IU School of MedicineIntroduction This study seeks to evaluate the incidence and associated risk factors of Clostridium difficile infection (CDI) in patients undergoing radical cystectomy (RC) for bladder cancer. Methods We retrospectively reviewed a single institution׳s bladder cancer database including all patients who underwent RC between 2010 and 2013. CDI was diagnosed by detection of Clostridium difficile toxin B gene using polymerase chain reaction–based stool assay in patients with clinically significant diarrhea within 90 days of the index operation. A multivariable logistic regression model was used to identify demographics and perioperative factors associated with developing CDI. Results Of the 552 patients who underwent RC, postoperative CDI occurred in 49 patients (8.8%) with a median time to diagnosis after RC of 7 days (interquartile range: 5–19). Of the 122 readmissions for postoperative complications, 10% (n = 12) were related to CDI; 2 patients died of sepsis directly related to severe CDI. On multivariate logistic regression, the use of chronic antacid therapy (odds ratio = 1.9, 95% CI: 1.02–3.68, P = 0.04) and antibiotic exposure greater than 7 days (odds ratio = 2.2, 95% CI: 1.11–4.44, P = 0.02) were independently associated with developing CDI. The use of preoperative antibiotics for positive findings on urine culture within 30 days before surgery was not statistically significantly associated with development of CDI (P = 0.06). Conclusions The development of CDI occurs in 8.8% of patients undergoing RC. Our study demonstrates that use of chronic antacid therapy and long duration of antimicrobial exposure are associated with development of CDI. Efforts focusing on minimizing antibiotic exposure in patients undergoing RC are needed, and perioperative antimicrobial prophylaxis guidelines should be followed.