Surgical Site Infection after Renal Transplantation

Harris, Anthony D.; Fleming, Brandon J.; Bromberg, Jonathan S.; Rock, Peter; Nkonge, Grace; Emerick, Michele; Harris-Williams, Michelle; Thom, Kerri A.

doi:10.1017/ice.2014.77

Cited by 49 publications

(33 citation statements)

References 25 publications

(35 reference statements)

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“…In this study and in prior studies, the positive and negative predictive values of the fields in the electronic medical record/central data repository were greater than 99%. 10-13 …”

Section: Methodsmentioning

confidence: 99%

Electronically Available Comorbid Conditions for Risk Prediction of Healthcare-Associated Clostridium difficile Infection

Harris

Sbarra

Leekha

et al. 2018

Infect. Control Hosp. Epidemiol.

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OBJECTIVE To analyze whether electronically available comorbid conditions are risk factors for Centers for Disease Control and Prevention (CDC)-defined, hospital-onset Clostridium difficile infection (CDI) after controlling for antibiotic and gastric acid suppression therapy use. PATIENTS Patients aged ≥18 years admitted to the University of Maryland Medical Center between November 7, 2015, and May 31, 2017. METHODS Comorbid conditions were assessed using the Elixhauser comorbidity index. The Elixhauser comorbidity index and the comorbid condition components were calculated using the International Classification of Disease, Tenth Revision, Clinical Modification (ICD-10-CM) codes extracted from electronic medical records. Bivariate associations between CDI and potential covariates for multivariable regression, including antibiotic use, gastric acid suppression therapy use, as well as comorbid conditions, were estimated using log binomial multivariable regression. RESULTS After controlling for antibiotic use, age, proton-pump inhibitor use, and histamine-blocker use, the Elixhauser comorbidity index was a significant risk factor for predicting CDI. There was an increased risk of 1.26 (95% CI, 1.19-1.32) of having CDI for each additional Elixhauser point added to the total Elixhauser score. CONCLUSIONS An increase in Elixhauser score is associated with CDI. Our study and other studies have shown that comorbid conditions are important risk factors for CDI. Electronically available comorbid conditions and scores like the Elixhauser index should be considered for risk-adjustment of CDC CDI rates. Infect Control Hosp Epidemiol 2018;39:297-301.

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“…In this study and in prior studies, the positive and negative predictive values of the fields in the electronic medical record/central data repository were greater than 99%. 10-13 …”

Section: Methodsmentioning

confidence: 99%

Electronically Available Comorbid Conditions for Risk Prediction of Healthcare-Associated Clostridium difficile Infection

Harris

Sbarra

Leekha

et al. 2018

Infect. Control Hosp. Epidemiol.

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“…9 Data contained within the tables of this repository have been validated for this and other research studies and were found to have positive and negative predictive values >99%. 10–12 In addition, a random sample of 2% of records had all data elements validated and the accuracy of the data was 100% for this dataset.…”

Section: Methodsmentioning

confidence: 99%

Pseudomonas aeruginosa Colonization in the Intensive Care Unit: Prevalence, Risk Factors, and Clinical Outcomes

Harris

Jackson

Robinson

et al. 2016

Infect. Control Hosp. Epidemiol.

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OBJECTIVE Determine the prevalence of Pseudomonas aeruginosa colonization on ICU admission, risk factors for P. aeruginosa colonization, and the incidence of subsequent clinical culture with P. aeruginosa among those colonized and not colonized. DESIGN A cohort study of patients admitted to the medical or surgical intensive care units between January 1, 2013, and December 31, 2013. SETTING A tertiary care hospital in Maryland. RESULTS 213 patients of 1840 patients (11.6%) were colonized with P. aeruginosa on ICU admission. Significant risk factors in the multivariable analysis for colonization were age (OR 1.02, 95% CI 1.01–1.03), anemia (1.90, 95% CI 1.05–3.42) and neurological disease (OR 1.80 95% CI 1.27–2.54). Among the 213 patients colonized with P. aeruginosa on admission, 60 (28.2%) had a subsequent clinical culture positive for P. aeruginosa on the current hospital admission (ICU period and post ICU period). 49 (82%) of the 60 patients had clinical infections. Among those not colonized on admission, only 68 (4.2%) had a subsequent clinical culture positive for P. aeruginosa on the current hospital admission. Patients colonized with P. aeruginosa were more likely to have a subsequent positive clinical culture than patients not colonized (IRR: 6.74, 95% CI: 4.91, 9.25). CONCLUSIONS These data emphasize the need to identify ICU patients colonized with P. aeruginosa on admission. Prediction rules or rapid diagnostic testing will help clinicians more appropriately choose empiric antibiotic therapy for subsequent infections.

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“…In particular, wound infections are responsible for longer hospitalizations, increased costs for antibiotic therapy and topical wound care during the same admission and after discharge. In addition, patients who develop wound complications have decreased functional capacity and rely on the assistance of family members or other providers who need to take time off work to drive patients to their frequent clinic appointments [22]. More importantly, in obese renal transplant recipients, surgical site infections (SSIs) have been associated with lower graft survival [15].…”

Section: The Economic and Clinical Burden Of Wound Infectionsmentioning

confidence: 99%

Robotic Versus Open Renal Transplantation in Obese Patients: Protocol for a Cost-Benefit Markov Model Analysis (Preprint)

Molinari¹,

Puttarajappa²,

Wijkstrom³

et al. 2017

Preprint

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A Markov model will be developed to simulate a randomized controlled study to assess the costeffectiveness of robotic-assisted renal transplantation in comparison to open surgery in obese patients. Project SummaryThe number of patients affected by renal insufficiency and obesity is growing, especially in North America where obesity has reached epidemic proportions. Obesity is associated with several comorbidities that increase the risks of wound complications. Wound infections are one of the most common nosocomial complications in patients who undergo contaminated surgical procedures or who are immunosuppressed or diabetic. Often, obese patients who undergo renal transplantation have diabetes in addition to being immunosuppressed and develop some degree of wound complications (infections, seromas, dehiscence, hernias) in up to 50% of cases. Wound complications represent a significant clinical and economic burden to the health-care system. In particular, wound infections are responsible for longer hospitalizations and decreased functional capacity of renal transplant recipients who require extramural nursing for the management of their wound-vacuum devices and local debridement and packing of their incisions.

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Surgical Site Infection after Renal Transplantation

Cited by 49 publications

References 25 publications

Electronically Available Comorbid Conditions for Risk Prediction of Healthcare-Associated Clostridium difficile Infection

Electronically Available Comorbid Conditions for Risk Prediction of Healthcare-Associated Clostridium difficile Infection

Pseudomonas aeruginosa Colonization in the Intensive Care Unit: Prevalence, Risk Factors, and Clinical Outcomes

Robotic Versus Open Renal Transplantation in Obese Patients: Protocol for a Cost-Benefit Markov Model Analysis (Preprint)

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