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1.
J Natl Cancer Inst ; 2021 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-33704460

RESUMO

BACKGROUND: Transgender persons face many barriers to healthcare that may delay cancer diagnosis and treatment, possibly resulting in decreased survival. Yet, data on cancer in this population are limited. We examined cancer stage at diagnosis, treatment, and survival among transgender patients compared to cisgender patients in the National Cancer Database (NCDB). METHODS: Gender (male, female, or transgender) was extracted from medical records from patients diagnosed with cancer between 2003-2016. Logistic regression estimated odds ratios (ORs) for the associations between gender and stage at diagnosis and treatment receipt. Cox proportional hazards regression estimated hazard ratios (HRs) for associations between gender and all-cause survival. RESULTS: Among 11,776,699 persons with cancer in NCDB, 589 were transgender. Compared to cisgender patients, transgender patients may be more likely to be diagnosed with advanced stage lung cancer (OR = 1.76, 95% confidence interval [CI]= 0.95, 3.28), less likely to receive treatment for kidney (OR = 0.19, 95%CI= 0.08, 0.47) and pancreas (OR = 0.33, 95%CI= 0.11, 0.95) cancers, and have poorer survival after diagnosis with non-Hodgkin lymphoma (HR = 2.34; 95%CI= 1.51, 3.63), prostate (HR = 1.91, 95%CI= 1.06, 3.45), and bladder cancers (HR = 2.86, 95%CI= 1.36, 6.00). Similar associations were found for other cancer sites, though not statistically significant. CONCLUSION: Transgender patients may be diagnosed at later stages, be less likely to receive treatment, and have worse survival for many cancer types. Small sample size hampered our ability to detect statistically significant differences for some cancer sites. There is a need for transgender-focused cancer research as the population ages and grows.

2.
Curr Sports Med Rep ; 20(2): 109-112, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33560035

RESUMO

ABSTRACT: The availability of handheld ultrasound offers physicians an opportunity to better define anatomy and pathophysiology, thus enhancing the diagnostic capabilities of a standard physical examination. The medical community increasingly embraces the potential for point-of-care ultrasound across medical specialties. The primary aim of this review was to identify and compile information on the current clinical utility of point-of-care ultrasound for musculoskeletal examination. This information will enable health care providers to understand the current utility and potential of musculoskeletal point-of-care ultrasound, thus facilitating its appropriate adoption into clinical practice.

3.
Sci Rep ; 11(1): 3686, 2021 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-33574564

RESUMO

Chile has high incidence rates of gallbladder cancer globally, particularly among Amerindian women, who also have a high prevalence of gallstones. We examined differences in inflammatory biomarkers between Mapuche and non-Mapuche women from the Chile Biliary Longitudinal Study, a cohort of women with ultrasound-detected gallstones. We randomly selected 200 Mapuche women frequency matched to non-Mapuche women on age and statin use Inflammatory biomarkers were analyzed using a multiplex assay and linear regression to assess associations of a priori markers (CCL20, CXCL10, IL-6, and IL-8) with ethnicity. Novel biomarkers were analyzed using exploratory factor analysis (EFA) and sufficient dimension reduction (SDR) to identify correlated marker groups, followed by linear regression to examine their association with ethnicity. The mean values of IL-8 were higher in Mapuche than non-Mapuche women (P = 0.04), while CCL20, CXCL10, and IL-6 did not differ significantly by ethnicity. EFA revealed two marker groups associated with ethnicity (P = 0.03 and P < 0.001). SDR analysis confirmed correlation between the biomarkers and ethnicity. We found higher IL-8 levels among Mapuche than non-Mapuche women. Novel inflammatory biomarkers were correlated with ethnicity and should be studied further for their role in gallbladder disease. These findings may elucidate underlying ethnic disparities in gallstones and carcinogenesis among Amerindians.

4.
Am J Epidemiol ; 190(2): 196-206, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33524121

RESUMO

Gallbladder cancer (GBC) is a highly fatal cancer that can be cured through cholecystectomy if identified early. The presence of gallstones is the primary risk factor for GBC, but few people with gallstones develop GBC. A key question is what drives the development of GBC among persons with gallstones. We initiated the Chile Biliary Longitudinal Study (Chile BiLS) to address this question. From 2016 to 2019, Chile BiLS enrolled 4,726 women aged 50-74 years with ultrasound-detected gallstones from southern-central Chile, accounting for an estimated 36% of eligible women with gallstones in the study area. The median age was 59 years; 25% of the women were Amerindian (Mapuche), 60% were obese, 25% had diabetes, and 6% had cardiovascular disease. Participants will be followed for gallbladder dysplasia or cancer for 6 years. As of April 30, 2020, over 91% of those eligible completed the year 2 follow-up visit. Data being collected include epidemiologic and sociodemographic information, anthropometric measurements, blood pressure, and tooth counts. Biosamples being taken include baseline plasma, buffy coat, red blood cells, serum, blood clot from serum, and PAXgene whole blood (PreAnalytiX GmbH, Hombrechtikon, Switzerland). Complete gallbladder sampling is conducted for most participants undergoing cholecystectomy. The Chile BiLS cohort study will increase our understanding of GBC etiology and could identify potential risk stratification and early detection strategies in high-risk areas.


Assuntos
Neoplasias da Vesícula Biliar/epidemiologia , Cálculos Biliares/epidemiologia , Idoso , Pressão Sanguínea , Pesos e Medidas Corporais , Doenças Cardiovasculares/epidemiologia , Chile , Diabetes Mellitus/epidemiologia , Feminino , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/etnologia , Cálculos Biliares/diagnóstico por imagem , Cálculos Biliares/etnologia , Humanos , Mediadores da Inflamação/sangue , Estudos Longitudinais , Pessoa de Meia-Idade , Obesidade/epidemiologia , Projetos de Pesquisa , Fatores de Risco , Fatores Socioeconômicos , Perda de Dente/epidemiologia
5.
Am J Epidemiol ; 2020 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-32935837

RESUMO

Gallbladder cancer (GBC) is a highly fatal cancer that can be cured through cholecystectomy if identified early. The presence of gallstones is the primary risk factor for GBC, but few individuals with gallstones develop GBC. A key question is what drives the development of GBC among individuals with gallstones. We initiated the Chile Biliary Longitudinal Study (Chile BiLS) to address this question. From 2016-2019, Chile BiLS enrolled 4,726 women aged 50-74 with ultrasound-detected gallstones from Southern-central Chile, accounting for an estimated 36% of eligible women with gallstones in the study area. The median age was 59 years, 25% were Amerindian (Mapuche), 60% were obese, 25% had diabetes, and 6% had cardiovascular disease. Participants will be followed for gallbladder dysplasia or cancer for six years. As of April 30, 2020, over 91% of those eligible completed the year-2 follow-up visit. Data include epidemiological and sociodemographic information, anthropometric measurements, blood pressure, and teeth count. Biosamples include baseline plasma, buffy coat, red blood cells, serum, blood clot, and PaxGene whole blood. Complete gallbladder sampling is conducted for most participants undergoing cholecystectomy. The Chile BiLS cohort will inform understanding of GBC etiology and could identify potential risk stratification and early detection strategies in high-risk areas.

7.
J Sports Med Phys Fitness ; 60(10): 1412-1414, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32586080

RESUMO

There are many causes of acute hip pain. Obturator internus (OI) muscle strain is a rare cause of the presentation. We report a case of OI muscle strain in a 15-year-old ski racer who presented with new onset acute right hip pain. Magnetic resonance imaging showed enhancement of the obturator internus muscle indicating muscle injury. Patient was treated conservatively with target physical therapy and NSAIDs for pain management. This case illustrates an atypical diagnosis for a common chief complaint.

8.
J Hepatol ; 73(4): 863-872, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32437829

RESUMO

BACKGROUND & AIMS: Gallbladder cancer (GBC) is known to have a female predominance while other biliary tract cancers (BTCs) have a male predominance. However, the role of female reproductive factors in BTC etiology remains unclear. METHODS: We pooled data from 19 studies of >1.5 million women participating in the Biliary Tract Cancers Pooling Project to examine the associations of parity, age at menarche, reproductive years, and age at menopause with BTC. Associations for age at menarche and reproductive years with BTC were analyzed separately for Asian and non-Asian women. Hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards models, stratified by study. RESULTS: During 21,681,798 person-years of follow-up, 875 cases of GBC, 379 of intrahepatic bile duct cancer (IHBDC), 450 of extrahepatic bile duct cancer (EHBDC), and 261 of ampulla of Vater cancer (AVC) occurred. High parity was associated with risk of GBC (HR ≥5 vs. 0 births 1.72; 95% CI 1.25-2.38). Age at menarche (HR per year increase 1.15; 95% CI 1.06-1.24) was associated with GBC risk in Asian women while reproductive years were associated with GBC risk (HR per 5 years 1.13; 95% CI 1.04-1.22) in non-Asian women. Later age at menarche was associated with IHBDC (HR 1.19; 95% CI 1.09-1.31) and EHBDC (HR 1.11; 95% CI 1.01-1.22) in Asian women only. CONCLUSION: We observed an increased risk of GBC with increasing parity. Among Asian women, older age at menarche was associated with increased risk for GBC, IHBDC, and EHBDC, while increasing reproductive years was associated with GBC in non-Asian women. These results suggest that sex hormones have distinct effects on cancers across the biliary tract that vary by geography. LAY SUMMARY: Our findings show that the risk of gallbladder cancer is increased among women who have given birth (especially women with 5 or more children). In women from Asian countries, later age at menarche increases the risk of gallbladder cancer, intrahepatic bile duct cancer and extrahepatic bile duct cancer. We did not see this same association in women from Western countries. Age at menopause was not associated with the risk of any biliary tract cancers.

11.
Clin Infect Dis ; 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31918439

RESUMO

BACKGROUND: The Centers for Medicare and Medicaid Services (CMS) use colon surgical site infection (SSI) rates to rank hospitals and apply financial penalties. CMS's risk adjustment model omits potentially impactful variables that might disadvantage hospitals with complex surgical populations. METHODS: We analyzed adult patients who underwent colon surgery within facilities associated with HCA Healthcare from 2014 to 2016. SSIs were identified from National Health Safety Network (NHSN) reporting. We trained and validated three SSI prediction models using 1) current CMS model variables, including hospital-specific random effects (HCA-adapted-CMS), 2) demographics and claims-based comorbidities (expanded-claims), and 3) demographics, claims-based comorbidities, and NHSN variables (claims-plus-EHR). Discrimination, calibration, and resulting rankings were compared among all models and the current CMS model with published coefficient values (CMS). RESULTS: We identified 39,468 colon surgeries in 149 hospitals resulting in 1,216 (3.1%) SSIs. Compared to the HCA-adapted-CMS model, the expanded-claims model had similar performance (c-statistic 0.65 vs 0.67), while the claims-plus-EHR model was more accurate (c-statistic 0.70, 95% CI: 0.67-0.73; p=0.004). The sampling variation due to low surgical volume and small number of infections contributed 74% of the total variation in observed SSI rates between hospitals. When CMS model rankings were compared to those from the expanded-claims and claims-plus-EHR models, eighteen (15%) and 26 (22%) hospitals changed quartiles, and 10 (8.3%) and 12 (10%) hospitals changed into or out of the lowest-performing quartile, respectively. CONCLUSIONS: An expanded set of variables improved colon SSI risk prediction and quartile assignment, but low procedure volumes and SSI events remain a barrier to effectively compare hospitals.

12.
Gene ; 730: 144289, 2020 Mar 10.
Artigo em Inglês | MEDLINE | ID: mdl-31846709

RESUMO

Interferon lambda proteins activate the JAK-STAT signalling pathway, resulting in upregulation of genes with antiviral effects. The interferon lambda family was initially thought to be redundant to the interferon alpha family, which signals through the same pathway, except for the more limited expression of the IFNLR1 receptor. However, recent studies show that interferon lambdas uniquely protect tissue barriers against a wide range of important viral infections. The interferon lambda 4 gene (IFNL4) was discovered in 2013. The IFNL4 protein is determined by the IFNL4-ΔG/TT (rs368234815) variant. The ancestral IFNL4-ΔG allele generates IFNL4, whereas IFNL4-TT causes pre-mature termination of the protein. Surprisingly, although interferons are generally antiviral proteins, the genotypes that generate the IFNL4 protein are strongly linked to impaired clearance of hepatitis C virus (HCV). IFNL4 genotype has also been linked to variation within the HCV genome, as well as risk of hepatic fibrosis, certain cancers and some infectious diseases. There has been very strong evolutionary selection against the ancestral IFNL4-ΔG allele, which is the major form in African populations, but the minor allele in Europeans and Asians. The reason for this selection and the biological mechanisms underlying observed phenotypic associations remain to be explained.


Assuntos
Interleucinas/genética , Interleucinas/metabolismo , Alelos , Grupos de Populações Continentais/genética , Evolução Molecular , Frequência do Gene/genética , Variação Genética/genética , Genótipo , Hepacivirus/genética , Hepatite/genética , Humanos , Interleucinas/fisiologia , Fenótipo , Polimorfismo de Nucleotídeo Único/genética
15.
J Orthop Trauma ; 33(10): 487-496, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31464855

RESUMO

OBJECTIVE: To describe the distribution of femoral neck shortening after internal fixation and to determine whether shortening is associated with inferior hip function at 24 months after a hip fracture in patients 50 years of age or older. DESIGN: Retrospective cohort study. SETTING: A secondary analysis of data from 81 clinical centers included in the Fixation using Alternative Implants for the Treatment of Hip Fractures (FAITH) trial. PARTICIPANTS: Three hundred fifty patients, 50 years of age or older, who had an isolated femoral neck fracture and underwent timely operative fixation of the fracture. INTERVENTION: Femoral neck shortening was measured as a categorical variable and classified into one of the following groups, as determined by the Central Adjudication Committee: no shortening, mild shortening (≤5 mm), moderate shortening (6-10 mm), or severe shortening (>10 mm). MAIN OUTCOME MEASUREMENT: The primary outcome for the current analysis was hip function, as measured by the Western Ontario & McMaster Universities Osteoarthritis Index questionnaire, at 24 months after injury. RESULTS: Two-thirds of patients had no or mild shortening (≤5 mm), whereas one-third of patients had moderate or severe shortening (>5 mm). After adjusting for surgical treatment, a greater amount of femoral neck shortening was found to be associated with poorer hip function (P < 0.01). CONCLUSIONS: We found that increasing femoral neck shortening was associated with inferior hip function. Although internal fixation often results in successful union, patients who heal in a shortened position report poorer functional outcomes. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Colo do Fêmur/patologia , Fixação Interna de Fraturas , Fraturas do Quadril/cirurgia , Complicações Pós-Operatórias/patologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Estudos Retrospectivos
16.
J Interferon Cytokine Res ; 39(10): 618-626, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31161939

RESUMO

Chronic infection with the hepatitis C virus (HCV) is a major cause of cirrhosis and hepatocellular carcinoma. In 2009, genome-wide association studies (GWAS) strongly linked genetic variants in the interferon lambda (IFN-λ) chromosomal region to HCV clearance. In 2013, discovery of the IFNL4 gene provided a functional explanation for those GWAS findings. The IFNL4-ΔG/TT (rs368234815) variant controls generation of the IFN-λ4 protein. Paradoxically, the IFNL4-TT allele, which abrogates IFN-λ4, associates with higher rates of spontaneous HCV clearance and better response to treatments for HCV infection. The finding that a "knock-out" allele for IFN-λ4 enhances HCV clearance challenges the paradigm of IFNs as antiviral cytokines. Genetic variants in the IFN-λ region have also been associated with hepatic inflammation and fibrosis from various etiologies, however, alleles that are linked with improved HCV clearance associates with worse inflammation and fibrosis. These studies demonstrate that GWAS of infectious diseases may yield important and unexpected biological insights.


Assuntos
Alelos , Variação Genética , Hepacivirus , Hepatite C Crônica , Interleucinas , Cirrose Hepática , Estudo de Associação Genômica Ampla , Hepacivirus/genética , Hepacivirus/metabolismo , Hepatite C Crônica/genética , Hepatite C Crônica/metabolismo , Hepatite C Crônica/patologia , Humanos , Interleucinas/genética , Interleucinas/metabolismo , Cirrose Hepática/genética , Cirrose Hepática/metabolismo , Cirrose Hepática/patologia , Cirrose Hepática/virologia
17.
Cancer Res ; 79(15): 3973-3982, 2019 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-31113819

RESUMO

Biliary tract cancers are rare but highly fatal with poorly understood etiology. Identifying potentially modifiable risk factors for these cancers is essential for prevention. Here we estimated the relationship between adiposity and cancer across the biliary tract, including cancers of the gallbladder (GBC), intrahepatic bile ducts (IHBDC), extrahepatic bile ducts (EHBDC), and the ampulla of Vater (AVC). We pooled data from 27 prospective cohorts with over 2.7 million adults. Adiposity was measured using baseline body mass index (BMI), waist circumference, hip circumference, waist-to-hip, and waist-to-height ratios. HRs and 95% confidence intervals (95% CI) were estimated using Cox proportional hazards models adjusted for sex, education, race, smoking, and alcohol consumption with age as the time metric and the baseline hazard stratified by study. During 37,883,648 person-years of follow-up, 1,343 GBC cases, 1,194 EHBDC cases, 784 IHBDC cases, and 623 AVC cases occurred. For each 5 kg/m2 increase in BMI, there were risk increases for GBC (HR = 1.27; 95% CI, 1.19-1.36), IHBDC (HR = 1.32; 95% CI, 1.21-1.45), and EHBDC (HR = 1.13; 95% CI, 1.03-1.23), but not AVC (HR = 0.99; 95% CI, 0.88-1.11). Increasing waist circumference, hip circumference, waist-to-hip ratio, and waist-to-height ratio were associated with GBC and IHBDC but not EHBDC or AVC. These results indicate that adult adiposity is associated with an increased risk of biliary tract cancer, particularly GBC and IHBDC. Moreover, they provide evidence for recommending weight maintenance programs to reduce the risk of developing these cancers. SIGNIFICANCE: These findings identify a correlation between adiposity and biliary tract cancers, indicating that weight management programs may help minimize the risk of these diseases.


Assuntos
Antropometria/métodos , Neoplasias do Sistema Biliar/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
18.
J Natl Cancer Inst ; 111(12): 1263-1278, 2019 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-31127946

RESUMO

BACKGROUND: Tobacco and alcohol are well-established risk factors for numerous cancers, yet their relationship to biliary tract cancers remains unclear. METHODS: We pooled data from 26 prospective studies to evaluate associations of cigarette smoking and alcohol consumption with biliary tract cancer risk. Study-specific hazard ratios (HRs) and 95% confidence intervals (CIs) for associations with smoking and alcohol consumption were calculated. Random-effects meta-analysis produced summary estimates. All statistical tests were two-sided. RESULTS: Over a period of 38 369 156 person-years of follow-up, 1391 gallbladder, 758 intrahepatic bile duct, 1208 extrahepatic bile duct, and 623 ampulla of Vater cancer cases were identified. Ever, former, and current smoking were associated with increased extrahepatic bile duct and ampulla of Vater cancers risk (eg, current vs never smokers HR = 1.69, 95% CI = 1.34 to 2.13 and 2.22, 95% CI = 1.69 to 2.92, respectively), with dose-response effects for smoking pack-years, duration, and intensity (all Ptrend < .01). Current smoking and smoking intensity were also associated with intrahepatic bile duct cancer (eg, >40 cigarettes per day vs never smokers HR = 2.15, 95 % CI = 1.15 to 4.00; Ptrend = .001). No convincing association was observed between smoking and gallbladder cancer. Alcohol consumption was only associated with intrahepatic bile duct cancer, with increased risk for individuals consuming five or more vs zero drinks per day (HR = 2.35, 95%CI = 1.46 to 3.78; Ptrend = .04). There was evidence of statistical heterogeneity among several cancer sites, particularly between gallbladder cancer and the other biliary tract cancers. CONCLUSIONS: Smoking appears to increase the risk of developing all biliary tract cancers except gallbladder cancer. Alcohol may increase the risk of intrahepatic bile duct cancer. Findings highlight etiologic heterogeneity across the biliary tract.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Neoplasias dos Ductos Biliares/etiologia , Neoplasias da Vesícula Biliar/etiologia , Fumar/efeitos adversos , Adulto , Fatores Etários , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Ampola Hepatopancreática , Neoplasias dos Ductos Biliares/epidemiologia , Ductos Biliares Extra-Hepáticos , Ductos Biliares Intra-Hepáticos , Neoplasias do Ducto Colédoco/epidemiologia , Neoplasias do Ducto Colédoco/etiologia , Intervalos de Confiança , Ex-Fumantes , Feminino , Neoplasias da Vesícula Biliar/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , não Fumantes , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fatores de Risco , Fatores Sexuais , Fumantes/estatística & dados numéricos , Fumar/epidemiologia
19.
Int J STD AIDS ; 30(5): 453-459, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30999831

RESUMO

Patient's gender may impact pharmacokinetics and play a role in viral suppression. Existing literature has focused on treatment-naïve patients and produced inconclusive results, often implicating differences in adherence as the driver of gender-based outcome differences. The present analysis assessed whether viral suppression on third-line HIV treatment among a closely followed population differs by gender. A retrospective cohort study of patients on third-line HIV treatment was initiated at the HIV Advanced Treatment Centre in Lusaka, Zambia between January 2012 and December 2015. The association between gender and viral suppression was assessed using log binomial regression adjusted for core drug, number of drug mutations, and baseline viral load. Of the 80 included patients (56% female; median age: 40 years), 50 (62%) were virally suppressed at six months. After adjustment, females were less likely to be virologically suppressed at six months on third-line treatment compared to male HIV patients (relative risk 0.82, 95% confidence interval: 0.56, 1.20). Our data suggest that women were less likely to be suppressed following six months of third-line therapy compared to men; however, the difference was not statistically significant. Larger studies are needed to determine whether women are at increased risk of viral failure on third-line therapy compared to men.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade/métodos , Infecções por HIV/tratamento farmacológico , HIV-1/efeitos dos fármacos , Carga Viral/efeitos dos fármacos , Adulto , Contagem de Linfócito CD4 , Farmacorresistência Viral/genética , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/virologia , HIV-1/genética , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais , Resultado do Tratamento , Zâmbia/epidemiologia
20.
Am J Infect Control ; 47(1): 13-17, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30268592

RESUMO

BACKGROUND: Health care workers (HCWs) are significant vectors for transmission of multidrug-resistant organisms among patients in intensive care units (ICUs). We studied ICU patients on contact precautions, colonized with vancomycin-resistant Enterococcus (VRE), to assess whether bacterial burden is associated with transmission to HCWs' gloves or gowns, a surrogate outcome for transmission to subsequent patients. METHODS: From this prospective cohort study, we analyzed 96 VRE-colonized ICU patients and 5 HCWs per patient. We obtained samples from patients' perianal area, skin, and stool to assess bacterial burden and cultured HCWs' gloves and gowns for VRE after patient care. RESULTS: Seventy-one of 479 (15%) HCW-patient interactions led to contamination of HCWs' gloves or gowns with VRE. HCW contamination was associated with VRE burden on the perianal swab (odds ratio [OR], 1.37; 95% confidence interval [CI], 1.19, 1.57), skin swabs (OR, 2.14; 95% CI, 1.51, 3.02), and in stool (OR, 1.95; 95% CI, 1.39, 2.72). Compared with colonization with Enterococcus faecalis, colonization with Enterococcus faecium was associated with higher bacterial burden and higher odds of transmission to HCWs. CONCLUSIONS: We show that ICU patients with higher bacterial burden are more likely to transmit VRE to HCWs. These findings have implications for VRE decolonization and other infection control interventions.


Assuntos
Carga Bacteriana , Enterococcus faecalis/isolamento & purificação , Enterococcus faecium/isolamento & purificação , Infecções por Bactérias Gram-Positivas/transmissão , Pessoal de Saúde , Transmissão de Doença Infecciosa do Paciente para o Profissional , Enterococos Resistentes à Vancomicina/isolamento & purificação , Idoso , Idoso de 80 Anos ou mais , Fezes/microbiologia , Feminino , Infecções por Bactérias Gram-Positivas/microbiologia , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Períneo/microbiologia , Equipamento de Proteção Individual/microbiologia , Estudos Prospectivos , Reto/microbiologia , Medição de Risco
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