Assessment of whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been propagated during intestinal passage and infectivity is conserved when shed rectally by hospitalized ...individuals.
An exploratory cohort study including 28 inpatients with coronavirus disease 2019 with estimation of RNA levels by RT-PCR and of viral infectivity by culturing of viral material sampled concomitantly and identically from pharynx and rectum.
SARS-CoV-2 RNA was detected more frequently (91%, 30/33 versus 42%, 14/33, p <0.0001) and at higher concentrations (median levels 2 190 186 IU/mL versus 13 014 IU/mL, p <0.0001) in the pharyngeal swabs than in the rectal swabs. For all sample pairs (n = 33) the rectal swabs contained undetectable or lower SARS-CoV-2 RNA concentrations than their paired pharyngeal swabs. Replicative virus was found in 37% (11/30) of the PCR-positive pharyngeal swabs, whereas none of the PCR-positive rectal swabs could be cultured (0%, 0/14) despite containing SARS-CoV-2 RNA concentrations up to 1 544 691 IU/mL.
Our data draw into question whether SARS-CoV-2 is transmitted readily from faeces.
Acute cholangitis (AC) is a condition of bacterial infection in the biliary tract with a high mortality rate of around 10%. Direct association between presence of bacteremia and 30-day mortality ...among AC patients is sparsely investigated and remains unclear.
Our aim was to investigate association between bacteremia and 30-day mortality among patients with AC included over a period of 25 years. All AC patients that underwent endoscopic retrograde cholangiopancreatography (ERCP) at Odense University Hospital, between 1 January 1990 and 31 October 2015, were identified using a prospective ERCP database. Blood culture results from the patients along with antimicrobial resistance patterns were collected from a bacteremia research database.
During the study period, 775 consecutive AC patients underwent ERCP and blood cultures were collected from 528 patients. Among these patients 48% (n = 260) had bacteremia. Overall, 30-day mortality in patients with blood cultures performed was 13% (n = 69). In patients with bacteremia, 30-day mortality was 19% (n = 49), compared to 7% (n = 20) in patients without bacteremia (p < .01). Presence of bacteremia was associated with increased 30-day mortality (OR 95% CI: 3.43 1.92-6.13; p < .01) following adjustment for confounding factors. Among the species, bacteremia with Enterobacter cloacae was significantly associated with increased 30-day mortality (OR 95% CI: 2.97 1.16-7.62; p = .02).
Our results indicate that presence of bacteremia was associated with a nearly fourfold increase in 30-day mortality among AC patients.
The aim of the study was to estimate risk factors for hospitalization due to sepsis and to determine whether these risk factors vary by age and gender.
We performed a population-based case-control ...study of all adult patients admitted to a medical ED from September 2010 to August 2011. Controls were sampled within the hospital catchment-area. All potential cases were manually validated using a structured protocol. Vital signs and laboratory values measured at arrival were registered to define systemic inflammatory response syndrome and organ dysfunction. Multivariable logistic regression was used to elucidate which predefined risk factors were associated with an increased or decreased risk hospitalization due to sepsis.
A total of 1713 patients were admitted with sepsis of any severity. The median age was 72 years (interquartile range: 57-81 years) and 793 (46.3%) were male. 621 (36.3%) patients were admitted with sepsis, 1071 (62.5%) with severe sepsis and 21 (1.2%) with septic shock. Episodes with sepsis of any severity were associated with older age (85+ years adjusted OR 6.02 95%CI: 5.09-7.12), immunosuppression (4.41 3.83-5.09), alcoholism-related conditions (2.90 2.41-3.50), and certain comorbidities: psychotic disorder (1.90 1.58-2.27), neurological (1.98 1.73-2.26), respiratory (3.58 3.16-4.06), cardiovascular (1.62 1.41-1.85), diabetes (1.82 1.57-2.12), cancer (1.44 1.22-1.68), gastrointestinal (1.71 1.44-2.05) and renal (1.46 1.13-1.89). The strength of the observed associations for comorbid factors was strongest among younger individuals.
Hospitalization due to sepsis of any severity was associated with several independent risk factors, including age and comorbid factors.
•Community-acquired bloodstream infection is associated with high morbidity and mortality.•Serial C-reactive protein (CRP) measurements were analyzed.•Individual patterns of CRP-ratio response ...identified short and long-term outcomes.•The addition of albumin further increased this ability.
We assessed C-reactive protein (CRP) and plasma albumin (PA) kinetics to evaluate community-acquired bloodstream infection (CA-BSI) patients’ 1-year outcomes.
Population-based study, with CRP and PA measurements on day 1 (D1) and D4. Relative CRP variations in relation to D1 CRP value were evaluated (CRP-ratio). Patients were classified as fast response, slow response, non-response, and biphasic response.
A total of 935 patients were included. At D4, the CRP-ratio was lower in survivors on D365 in comparison with D4–D30 non-survivors and D30–D365 non-survivors (p<0.001). In comparison with fast response patients, non-response and biphasic response patients had 2.74 and 5.29 increased risk, respectively, of death in D4–D30 and 2.77 and 3.16 increased risk, respectively, of death in D31–D365. PA levels remained roughly unchanged from D1–D4, but lower D1 PA predicted higher short and long-term mortality (p<0.001). The discriminative performance of the CRP-ratio and D1 PA to identify patients with poor short and long-term mortality after adjustments was acceptable (AUROC=0.79).
Serial CRP measurements at D1 and D4 after CA-BSI is clinically useful to identify patients with poor outcome. Individual patterns of CRP-ratio response with PA at D1 further refine our ability of predicting short or long-term mortality.
Summary Objectives Little is known about long-term outcomes following bacteremia. We investigated long-term mortality and causes of death among bacteremia patients compared with population controls. ...Methods Population-based cohort study of bacteremia patients and population controls matched on sex, year of birth, residency and calendar time, in Denmark during 2000–2008. We calculated absolute mortality and adjusted mortality rate ratios (MRRs) in predefined follow-up periods. Results The absolute mortality for bacteremia patients ( n = 7783) and population controls ( n = 38,906) was 22.0% vs. 0.2% (30 days), 41.4% vs. 2.6% (1 year) and 75.8% vs. 36.6% (10 years). For bacteremia patients, the MRR was 115.3 (95% CI, 88.2–150.9) 0–30 days after bacteremia and 2.1 (95% CI, 1.8–2.3) from 5 years to end of follow-up. The most common causes of death were cancer and cardiovascular diseases. Within one year of bacteremia, the relative risk of death was highest for genitourinary diseases and infectious diseases. Among one-year survivors of bacteremia, the relative risk of death was increased for all major causes of death. Conclusions Bacteremia is associated with a poor prognosis and considerable excess long-term mortality compared with the general population. The most common causes of death after bacteremia are cancer and cardiovascular diseases. Summary This population-based cohort study reports an excess long-term mortality among 7783 bacteremia patients compared with matched population controls during 12 years of follow-up. We identified patients in particular risk of death and reported novel information on causes of death.
Background: As little is known about the ability to work in patients with infectious spondylodiscitis, we compared the relation between the workforce before infection with that of a reference ...population and described the patients' ability to work after infection including predictors of return to work (RTW).
Methods: We identified all patients aged 20-57 years treated for infectious spondylodiscitis January 1994-May 2009 at hospitals in Funen County, Denmark. The work status of each week from 2 years before until 2 years after index date was compared with that of a reference population. Time to RTW was described using cumulative incidence curves and univariate cause-specific Cox-regression analyses (hazard ratios - HRs).
Results: Of 112 identified patients, 8 (7%) died within the first year and 48 (43%) were part of the workforce 1 year before index. Through the entire observation period, the patients had lower affiliation to the workforce compared with the reference population. During the observation period, the proportion of patients on permanent disability pension increased from 24% to 38% and the proportion of self-supporters decreased from 58% to 33%. Seventy-three per cent of the patients being part of the workforce 1 year before index returned to the workforce within the 2 year follow-up. Main predictor of RTW was being part of the workforce 1 year before index (HR = 7.8; CI: 2.4-25.3).
Conclusions: Patients with infectious spondylodiscitis were less likely to be part of the workforce before infection compared with a reference population and infection further lowered their ability to RTW.
We developed four algorithms for the automatic capture of C-reactive protein (CRP) peaks in 296 adult patients with acute myeloid leukemia who had bloodstream infection (BSI) episodes, negative blood ...cultures (BCs) or possible infections where no BCs were performed. The algorithms detected CRP peaks for 418–446 of the 586 documented BSI episodes (71.3–76.1%) and 2714–3118 of the 4382 negative BCs (61.9–71.2%). The four algorithms captured 382–789 CRP peaks in which there were neither BSI episodes nor negative BCs. We conclude that automatic capture of CRP peaks is a tool for the monitoring of BSI episodes and possibly other infections in patients with acute myeloid leukemia.
Background We investigated the overall and daily incidence of bacteremia among hospitalized patients and evaluated the traditional classification of bacteremia (community-onset vs nosocomial based on ...a 48-hour time window) by means of the daily incidence and associated 30-day mortality. Methods In a multicenter hospital-based cohort study, we included all patients aged 15 years or older admitted to hospitals in Funen County, Denmark, during 2000-2008, and identified all first bacteremias per admission. We calculated the overall incidence of bacteremia per 1,000 admissions and 10,000 bed-days, as well as the daily incidence of bacteremia per 10,000 bed-days and associated 30-day mortality. Results We included 724,339 admissions and 10,281 bacteremias for an overall incidence of 14.2 per 1,000 admissions and 23.6 per 10,000 bed-days. The daily incidence was highest on the first 2 days of admission followed by lower incidences that were constant beyond day 12, but varied according to patient and epidemiologic characteristics. Thirty-day mortality for patients with bacteremia was 18% on day 1, 21% on day 2, and between 25% and 35% thereafter. Conclusions Hospitalized patients were at the highest risk of bacteremia during the first 2 days followed by lower incidences that were constant beyond day 12. Thirty-day mortality was 18%-21% for patients with bacteremia on the first 2 days and 25%-35% thereafter. Our findings support the traditional classification of bacteremia.
To assess trajectory patterns of C-reactive protein (CRP) and plasma albumin (PA) levels around bacteremia.
Population-based study, 2418 community-acquired bacteremia patients, CRP and PA specimens ...from 30 days before through 30 days after bacteremia (day 0). A pattern was based on specimen occurring or not in days -30/-1, 0, 1/7 or 8/30. Mean daily CRP and PA levels on day -30/30 were computed for pattern subgroups.
Mean CRP rose on day -5 and reached its peak on day 1. Mean steady PA on day -30/0 declined abruptly on day 1, increasing slowly thereafter. Trajectories did not differ between subgroups. We conclude that longitudinal analysis results can be extrapolated to all community-acquired bacteremia patients.
We aimed to examine if severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) cycle quantification (C.sub.q) value, as a surrogate for SARS-CoV-2 viral load, ...could predict hospitalisation and disease severity in adult patients with coronavirus disease 2019 (COVID-19). We performed a prospective cohort study of adult patients with PCR positive SARS-CoV-2 airway samples including all out-patients registered at the Department of Infectious Diseases, Odense University Hospital (OUH) March 9-March 17 2020, and all hospitalised patients at OUH March 10-April 21 2020. To identify associations between C.sub.q -values and a) hospital admission and b) a severe outcome, logistic regression analyses were used to compute odds ratios (OR) and 95% Confidence Intervals (CI), adjusting for confounding factors (aOR). We included 87 non-hospitalised and 82 hospitalised patients. The median baseline C.sub.q -value was 25.5 (interquartile range 22.3-29.0). We found a significant association between increasing C.sub.q -value and hospital-admission in univariate analysis (OR 1.11, 95% CI 1.04-1.19). However, this was due to an association between time from symptom onset to testing and C.sub.q -values, and no association was found in the adjusted analysis (aOR 1.08, 95% CI 0.94-1.23). In hospitalised patients, a significant association between lower C.sub.q -values and higher risk of severe disease was found (aOR 0.89, 95% CI 0.81-0.98), independent of timing of testing. SARS-CoV-2 PCR C.sub.q -values in outpatients correlated with time after symptom onset, but was not a predictor of hospitalisation. However, in hospitalised patients lower C.sub.q -values were associated with higher risk of severe disease.
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