Viral etiology of acute respiratory tract infection among children under 5 years of age in Kunming City, China: a matched case-case-control study.

AIMS: Nucleic acid-based molecular techniques in current laboratory practice allow the identification of a broad range of respiratory viruses. However, due to asymptomatic carriage, the detection of viruses in the respiratory tract does not necessarily indicate disease. The study aimed to investigate infections of different viruses that colonize the airways, the viral combinations in coinfection, and the viral association with the occurrence of either upper respiratory tract infection (AURTI) or lower respiratory tract infection (ALRTI) in children. METHODS AND RESULTS: A matched case-case-control study included ALRTI cases, AURTI cases, and healthy controls was conducted at Kunming Children's Hospital. Oropharyngeal swabs from the three groups were collected for eight viral pathogens detection by multiplex RT-PCR. The association of each pathogen with disease status was determined by comparing the results between cases and controls. From 1 March 2021 through 28 February 2022, 278 participants in each group were investigated. Viral infection was detected in 54.0%, 37.1%, and 12.2% of the ALRTI cases, AURTI cases, and healthy controls, respectively. Human respiratory syncytial virus (RSV), adenovirus (ADV), and parainfluenza virus-3 (PIV-3) were the most frequently documented viruses. RSV/ADV was the most frequent combination detected in coinfection. When compared to healthy controls, RSV and PIV-3 were independently associated with both ALRTI and AURTI. CONCLUSIONS: RSV and PIV-3 were causes of both ALRTI and AURTI cases. These results provide initial evidence of the potential of microbiota-based diagnostics for the differential diagnosis of severe acute respiratory infections using oropharyngeal swab samples.

Analysis of risk factors associated with healthcare-associated carbapenem-resistant Klebsiella pneumoniae infection in a large general hospital: a case-case-control study.

Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection is a major public health threat in the world. To inform the prevention and control of CRKP infection in hospitals, this study analyzed the factors associated with CRKP infection and resistance to carbapenems in K. pneumoniae. This case-case-control study was carried out in a large general hospital in China from January 2016 to December 2018, comprising 494 hospitalized patients infected with CRKP (case group 1) and 2429 hospitalized patients infected with carbapenem-susceptible K. pneumoniae (CSKP, case group 2). We selected control groups from hospitalized patients without K. pneumoniae infections for the two case groups separately, with a 1:3 case-control ratio, to analyze the risk factors of the two case groups using the conditional logistic regression. Multivariate analysis showed that the risk factors of CRKP infection were intensive care unit (ICU) admission (odds ratio [OR], 6.85; 95% confidence interval [CI], 4.90-9.58; P < 0.001), respiratory failure (OR, 1.93; 95% CI, 1.34-2.77; P < 0.001), age-adjusted Charlson comorbidity index (aCCI; OR, 1.08; 95% CI, 1.02-1.15; P = 0.007), admission from the Emergency (OR, 1.37; 95% CI, 1.02-1.85; P = 0.036), and imipenem use (OR, 1.80; 95% CI, 1.30-2.49; P < 0.001). Among the aforementioned five risk factors, aCCI (OR, 1.09; 95% CI, 1.06-1.13; P < 0.001) was also identified as a risk factor of CSKP infections in multivariate analysis. The risk factors for resistance to carbapenems in K. pneumoniae were ICU admission, respiratory failure, admission from the Emergency, and imipenem use.

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OBJECTIVES: To identify risk factors for carbapenem-resistant Klebsiella pneumoniae (CRKP) infection and death in hospitalized children in pediatric hospitals, and to provide a basis for the prevention and control of such infection. METHODS: This is a matched case-case-control study. The medical data of 81 children with CRKP infection and 81 children with carbapenem-sensitive Klebsiella pneumoniae (CSKP) infection who were hospitalized in Kunming Children's Hospital from January 2019 to October 2021 were retrospectively analyzed. A total of 162 children without CRKP or CSKP infection were enrolled as the control group. The association of underlying disease, previous hospitalization exposure, and current hospitalization exposure with CRKP infection and death was identified. RESULTS: Compared with the control group, there was a higher correlation between the history of hospitalization in the past 3 months and CRKP and CSKP infections (OR=14.25 and 10.07 respectively, P<0.01). The use of carbapenem in the past 3 months (OR=16.54, P<0.01) and central venous catheterization during the current hospitalization (OR=33.03, P<0.01) were risk factors for CRKP infection. The use of carbapenem in the past 3 months (OR=28.33, P<0.01) and empirical antibiotic use during the current hospitalization (OR=14.5, P<0.01) were risk factors for death of the children with CRKP infection. CONCLUSIONS: The history of hospitalization and the history of treatment with carbapenems in the past 3 months and invasive procedure after admission are leading influencing factors for CRKP infection and prognosis. It is necessary for pediatric hospitals to conduct CRKP screening on admission, standardize antibiotic use, and strengthen nosocomial infection surveillance, so as to decrease the incidence of CRKP infection.

Risk factors for Cutibacterium acnes spinal implant-associated infection: a case-case-control study.

OBJECTIVES: The aim was to determine the characteristics of patients who developed Cutibacterium acnes spinal implant-associated infection (SIAI) and the associated risk factors. METHODS: We conducted two parallel case-control studies comparing 59 patients with SIAI caused by C. acnes (cases 1) and 93 patients with SIAI caused by other microorganisms (cases 2) diagnosed during 2010-2015 with 302 controls who underwent spinal instrumentation without subsequent infection. RESULTS: Late-onset infections (median time to diagnosis, 843 days versus 23 days; p < 0.001) were more common in cases 1 than in cases 2. However, 20/59 (34%) of cases 1 occurred within the first 3 months after the index surgery. In addition, cases 1 were less likely to have fever (27%, 16/59 versus 58%, 54/93; p 0.001) or wound inflammation (39%, 23/59 versus 72%, 67/93; p < 0.001). Moreover, 24/59 (40%) of cases 1 presented with polymicrobial infections, and staphylococcal pathogens accounted for 22/24 (92%) of the co-infections. By comparing and contrasting the two multivariate risk models (cases 1 versus controls and cases 2 versus controls), the following factors associated with C. acnes SIAI development were identified: age <54 years (adjusted odds ratio (aOR) 2.43, 95% confidence interval (CI) 1.09-5.58, p 0.03), a body mass index <22 kg/m2 (aOR 2.47, 95% CI 1.17-5.29, p 0.02), and thoracic instrumentation (aOR 16.1, 95% CI 7.57-37.0, p < 0.001). CONCLUSIONS: Future therapeutic and prophylactic studies on C. acnes SIAI should focus on young, thin patients who undergo spinal instrumentation procedures involving the thoracic spine.

Case-case-control study of risk factors of carbapenem-resistant Acinetobacter baumannii infection / 中华临床感染病杂志

Objective To assess the risk factors of carbapenem -resistant Acinetobacter baumannii (CRAB) infection.Methods Clinical data of patients with positive bacterial culture in Tianjin Medical University General Hospital during January 2011 and December 2015 were retrospectively analyzed, including 68 patients with carbapenem resistant Acinetobacter baumannii (CRAB) bacteremia, 68 patients with carbapenem sensitive Acinetobacter baumannii ( CSAB) bacteremia, and 68 patients with positive culture of other bacteria (control group).The risk factors of Acinetobacter baumannii infection were analyzed by univatiate and multivariate Logistic regression analyses .Results Univariate analysis showed that bacteremia /sepsis,use of carbapenems,β-lactamase inhibitor compound,tigecycline,combined antibiotics, glucocorticoids,surgery within one month, mechanical ventilation, central venous catheters ( CVCs ), arteriopuncture,indwelling catheter≥3 days and indwelling gastric tube were risk factors of CRAB infection (CRAB vs.control: χ2 =4.96,15.56,7.64,9.22,5.89,6.80,17.00,11.83,18.22,8.24,25.24 and 7.70, P <0.05 or P <0.01, respectively); while use of third-generation cephalosporin,CVCs,length of hospital stay were risk factors of CSAB infection (CSAB vs.control: χ2 =11.93 and 6.94,U =1555, P <0.05).Multivariate logistic analysis showed that bacteremia /sepsis (OR =4.01, 95%CI:1.13 ~14.20), use of carbapenems (OR =4.17, 95%CI :1.79 ~9.73), CVCs (OR =2.93, 95% CI: 1.22 ~7.08), indwelling catheter≥3 days (OR =6.08,95%CI:2.39 ~15.46) were independent risk factors of CRAB infection; use of third-generation cephalosporin (OR =3.98, 95% CI :1.88 ~8.43 ),CVCs(OR =3.40, 95% CI:1.48 ~7.81) were independent risk factors of CSAB infection .Conclusions Long-term use of carbapenems and invasive procedures are associated with CRAB infection , strict control of invasive procedures and rational use of antibiotics may reduce CRAB infection .

A case -case control study on risk factors of the re -treatment multidrug resistant pulmonary tuberculosis / 预防医学

Objective To explore the risk factors of patients with re -treatment multidrug resistant pulmonary tuberculosis (MDR -TB)and to provide suggestions for intervention.Methods A case -case control study was carried out between patients with or without re -treatment MDR -TB,with a questionnaire interview and multivariate logistic regression analysis to explore the risk factors of re -treatment MDR -TB.Results A total of 172 patients were enrolled in this study including 99 re -treatment MDR -TB patients and 73 re -treatment non -MDR -TB patients(P >0.05).There was no significant difference between case group and control group in gender,age,residence and marital status.The sick time,the anti -tuberculosis treatment time,the number of anti -tuberculosis treatments,the rate of adverse reactions,history of taking isoniazid or rifampicin and the number of treatment interruption were higher in cases than those in control group(P <0.05),while the months of first -treatment were lower than those in control group(P <0.05).The number of anti -tuberculosis treatments(≥3),adverse reactions during treatment,the months of first -treatment were significant risk factors by the multivariable regression model,with the adjusted ORs and 95%CIs of 5.07 (1.89,13.64),4.27 (2.04, 8.94)and 2.35(1.06,5.22),respectively.Conclusion The number of anti -tuberculosis treatments,adverse reactions during treatment,the months of first -treatment were risk factors of patients with re -treatment MDR -TB.

Fluoroquinolone use is a risk factor for methicillin-resistant Staphylococcus aureus acquisition in long-term care facilities: a nested case-case-control study.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization is a well-established risk factor for subsequent infection and a key event in interindividual transmission. Some studies have showed an association between fluoroquinolones and MRSA colonization or infection. The present study was performed to identify specific risk factors for MRSA acquisition in long-term care facilities (LTCFs). METHODS: A prospective cohort of patients naive for S. aureus colonization was established and followed (January 2008 through October 2010) in 4 French LTCFs. Nasal colonization status and potential risk factors were assessed weekly for 13 weeks after inclusion. Variables associated with S. aureus acquisition were identified in a nested-matched case-case-control study using conditional logistic regression models. Cases were patients who acquired MRSA (or methicillin-sensitive S. aureus [MSSA]). Patients whose nasal swab samples were always negative served as controls. Matching criteria were center, date of first nasal swab sample, and exposure time. RESULTS: Among 451 included patients, 76 MRSA cases were matched to 207 controls and 112 MSSA cases to 208 controls. Multivariable analysis retained fluoroquinolones (odds ratio, 2.17; 95% confidence interval, 1.01-4.67), male sex (2.09; 1.10-3.98), and more intensive care at admission (3.24; 1.74-6.04) as significantly associated with MRSA acquisition, and body-washing assistance (2.85; 1.27-6.42) and use of a urination device (1.79; 1.01-3.18) as significantly associated with MSSA acquisition. CONCLUSIONS: Our results suggest that fluoroquinolones are a risk factor for MRSA acquisition. Control measures to limit MRSA spread in LTCFs should also be based on optimization of fluoroquinolone use.