Development and internal validation of clinical prediction models for outcomes of complicated intra-abdominal infection.

BACKGROUND: Complicated intra-abdominal infections (cIAIs) are associated with significant morbidity and mortality. The aim of this study was to describe the clinical characteristics of patients with cIAI in a multicentre study and to develop clinical prediction models (CPMs) to help identify patients at risk of mortality or relapse. METHODS: A multicentre observational study was conducted from August 2016 to February 2017 in the UK. Adult patients diagnosed with cIAI were included. Multivariable logistic regression was performed to develop CPMs for mortality and cIAI relapse. The c-statistic was used to test model discrimination. Model calibration was tested using calibration slopes and calibration in the large (CITL). The CPMs were then presented as point scoring systems and validated further. RESULTS: Overall, 417 patients from 31 surgical centres were included in the analysis. At 90 days after diagnosis, 17.3 per cent had a cIAI relapse and the mortality rate was 11.3 per cent. Predictors in the mortality model were age, cIAI aetiology, presence of a perforated viscus and source control procedure. Predictors of cIAI relapse included the presence of collections, outcome of initial management, and duration of antibiotic treatment. The c-statistic adjusted for model optimism was 0.79 (95 per cent c.i. 0.75 to 0.87) and 0.74 (0.73 to 0.85) for mortality and cIAI relapse CPMs. Adjusted calibration slopes were 0.88 (95 per cent c.i. 0.76 to 0.90) for the mortality model and 0.91 (0.88 to 0.94) for the relapse model; CITL was -0.19 (95 per cent c.i. -0.39 to -0.12) and - 0.01 (- 0.17 to -0.03) respectively. CONCLUSION: Relapse of infection and death after complicated intra-abdominal infections are common. Clinical prediction models were developed to identify patients at increased risk of relapse or death after treatment, these now require external validation.

Prevalence of rubella-IgG antibody in women of childbearing age in Lagos, Nigeria.

The prevalence of Rubella-IgG antibody was assessed in 152 Nigerian women consisting of 62 pregnant women. 82 non-pregnant women of childbearing age and 7 women who had suffered miscarriage. Rubella-IgG antibody was detected in sera of the female subjects by Immunocomb II Rubella IgG test kit (Orgenics, Israel) which is an indirect solid face Immunoassay (EIA). Rubella-IgG antibody was detected in 76% of pregnant women, 77% of non-pregnant women of childbearing age and 86% of women who had miscarriage. Similarly, the Rubella-IgG antibody titres of between 15 iu/ml and 120 iu/ml was encountered among the female subjects. Thus in general 77% of all the female subjects were positive for Rubella-IgG antibody while 23% had no detectable Rubella IgG antibody. There is need to protect this set of people considering the potential dangers of congenital anomalies associated with Rubella infection during pregnancy. The implications of the presence or absence of Rubella IgG antibody and titres are discussed.

Seasonal occurrence of vibrios in water and shellfish obtained from the Great Kwa River estuary, Calabar, Nigeria.

The prevalence of Vibrio species in shellfish and their seasonal variability in the Great Kwa River estuary (GKWE) were examined. Results revealed a trimodal peak in Vibrio counts, coinciding with meteorological changes and the hot periods of the year. The estuary was constantly faecally polluted, coupled with high rates of infection of shellfish by V. parahaemolyticus 42 (13.6%), V. cholerae non-01 29 (9.4%) and V. alginolyticus 22 (7.1%), thus posing a health risk. The observed seasonal variability and prevalence of Vibrio species infection are of epidemiological significance, and provide a guide for effective control of associated cholera epidemics.