Thirty-day readmissions in surgical and transcatheter aortic valve replacement: A systematic review and meta-analysis

Background: The 30-day all-cause readmission rate after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) vary substantially. We conducted a systematic review and meta-analysis to examine the overall incidence, causes, and risk factors of 30-day all-cause readmission rate after SAVR and TAVR. Methods: Eight medical research databases were searched; Cochrane, Medline, Embase, UpToDate, PROSPERO, National Guideline Clearinghouse, SweMed and Oria. We followed The Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) for this study. Results: Thirty-three articles were included in the systematic review, 32 of which were appropriate for the meta-analysis. Overall, 17% (95% CI: 16–18%) of patients in the SAVR group, and 16% (95% CI: 15–18%) in the TAVR groups were readmitted within 30 days. Heart failure, arrhythmia, infection, and respiratory problems were the most frequent causes of all-cause readmission after SAVR and TAVR. Most frequent reported prior risk factors for all-cause readmission following TAVR were diabetes, chronic lung disease/chronic obstructive pulmonary disease, atrial fibrillation, kidney problems, and transapical approach/nonfemoral access. For SAVR, no risk factors for 30-day all-cause readmission were reported in the literature to date. Conclusion: In conclusion, the overall proportion of 30-day all-cause readmission after SAVR and TAVR are high. Interventions to prevent avoidable readmissions ought to be developed and implemented

Thirty-day readmissions in surgical and transcatheter aortic valve replacement: A systematic review and meta-analysis

BACKGROUND: The 30-day all-cause readmission rate after surgical aortic valve replacement (SAVR) and transcatheter aortic valve replacement (TAVR) vary substantially. We conducted a systematic review and meta-analysis to examine the overall incidence, causes, and risk factors of 30-day all-cause readmission rate after SAVR and TAVR. METHODS: Eight medical research databases were searched; Cochrane, Medline, Embase, UpToDate, PROSPERO, National Guideline Clearinghouse, SweMed and Oria. We followed The Preferred Reporting Items for Systematic reviews and Meta-analysis (PRISMA) for this study. RESULTS: Thirty-three articles were included in the systematic review, 32 of which were appropriate for the meta-analysis. Overall, 17% (95% CI: 16-18%) of patients in the SAVR group, and 16% (95% CI: 15-18%) in the TAVR groups were readmitted within 30 days. Heart failure, arrhythmia, infection, and respiratory problems were the most frequent causes of all-cause readmission after SAVR and TAVR. Most frequent reported prior risk factors for all-cause readmission following TAVR were diabetes, chronic lung disease/chronic obstructive pulmonary disease, atrial fibrillation, kidney problems, and transapical approach/nonfemoral access. For SAVR, no risk factors for 30-day all-cause readmission were reported in the literature to date. CONCLUSION: In conclusion, the overall proportion of 30-day all-cause readmission after SAVR and TAVR are high. Interventions to prevent avoidable readmissions ought to be developed and implemented.status: publishe

Risk Factors for Community-Acquired Urinary Tract Infections Caused by ESBL-Producing Enterobacteriaceae -A Case-Control Study in a Low Prevalence Country

Community-acquired urinary tract infection (CA-UTI) is the most common infection caused by extended-spectrum blactamase (ESBL)-producing Enterobacteriaceae, but the clinical epidemiology of these infections in low prevalence countries is largely unknown. A population based case-control study was conducted to assess risk factors for CA-UTI caused by ESBL-producing E. coli or K. pneumoniae. The study was carried out in a source population in Eastern Norway, a country with a low prevalence of infections caused by ESBL-producing Enterobacteriaceae. The study population comprised 100 cases and 190 controls with CA-UTI caused by ESBL-producing and non-ESBL-producing E. coli or K. pneumoniae, respectively. The following independent risk factors of ESBL-positive UTIs were identified: Travel to Asia, The Middle East or Africa either during the past six weeks (Odds ratio (OR) = 21; 95% confidence interval (CI): 4.5–97) or during the past 6 weeks to 24 months (OR = 2.3; 95% CI: 1.1–4.4), recent use of fluoroquinolones (OR = 16; 95% CI: 3.2–80) and b-lactams (except mecillinam) (OR = 5.0; 95% CI: 2.1–12), diabetes mellitus (OR = 3.2; 95% CI: 1.0–11) and recreational freshwater swimming the past year (OR = 2.1; 95% CI: 1.0–4.0). Factors associated with decreased risk were increasing number of fish meals per week (OR = 0.68 per fish meal; 95% CI: 0.51–0.90) and age (OR = 0.89 per 5 year increase; 95% CI: 0.82–0.97). In conclusion, we have identified risk factors that elucidate mechanisms and routes for dissemination of ESBL-producing Enterobacteriaceae in a low prevalence country, which can be used to guide appropriate treatment of CA-UTI and targeted infection control measures

Demographic and clinical characteristics of the study population with and without ESBL positive urinary tract infection.^a

a<p>Data are presented as the absolute number of patients with percentages in parentheses with the exception of age and household members, which is listed as mean value ± standard deviation (SD).</p>b<p>Some variables have missing values (number of missing patients in parentheses): Household members (2), Charlson comorbidity index score (8) Pulmonary disease (2) Rheumatic disease (1), Malignancy (2), Diseases of the gastrointestinal tract (1), Cardiac disease (4), Renal dysfunction (1), Hepatic dysfunction (1), Cerebrovascular disease (2), Urinary catheter (6).</p>c<p>Excluding the time period from 24 hours to 31 days before the urinary sample was taken. No patient had resided in a nursing home without being hospitalized in the time period.</p>d<p>To quantify the number of UTIs for each patient in the preceding year, the number of prescriptions of three antimicrobial agents–trimethoprim, mecillinam, and nitrofurantoin–were counted. In Norway, these agents are first choices for UTI treatment and are not used for other infections. Recurrent UTI was defined as ≥3 UTIs during the past year.</p

Comparison of the antibiotic usage during the last 90 days prior to inclusion in the study population with and without ESBL positive urinary tract infection.

a<p>Number of subjects who had used at least one dose in the past 90 days.</p>b<p>Six cases and 17 controls received an antimicrobial agent at the day before the urinary sample only.</p>c<p>Penicillin, amoxicillin, cloxacillin or cephalexin (some patients used more than one type).</p

Independent risk factors of ESBL positive community acquired urinary tract infection identified using multivariate logistic regression analysis.

a<p>Only trips lasting >24 hours are included.</p