Interobserver agreement of the modified Paris classification and histology prediction of colorectal lesions in patients with inflammatory bowel disease

BACKGROUND AND AIMS

SCENIC (International Consensus Statement on Surveillance and Management of Dysplasia in IBD) guidelines recommend that visible dysplasia in patients with longstanding inflammatory bowel disease (IBD) should be endoscopically characterized using a modified Paris classification. This study aimed to determine the interobserver agreement (IOA) of the modified Paris classification and endoscopists' accuracy for pathology prediction of IBD visible lesions.

METHODS

One hundred deidentified endoscopic still images and 30 videos of IBD visible colorectal lesions were graded by 10 senior and 4 trainee endoscopists from 5 tertiary care centers. Endoscopists were asked to assign 4 classifications for each image: the standard Paris classification, modified Paris classification, pathology prediction, and lesion border. Agreement was measured using Light's kappa coefficient. Consensus of ratings was assessed according to strict majority.

RESULTS

The overall Light's kappa for all study endpoints was between .32 and .49. In a subgroup analysis between junior and senior endoscopists, Light's kappa continued to be less than .6 with a slightly higher agreement among juniors. Lesions with the lowest agreement and no consensus were mostly classified as Is, IIa, and mixed Paris classification and sessile and superficial elevated for modified Paris classification. Endoscopist accuracy for prediction of dysplastic, nondysplastic, and serrated pathology was 77%, 56%, and 30%, respectively. There was a strong association (P < .001) between the given morphology classification and the predicted pathology with Ip lesions carrying a much lower expectation of dysplasia than Is/IIc/III and mixed lesions. The agreement for border prediction was .5 for junior and .3 for senior endoscopists.

CONCLUSIONS

This study demonstrates very low IOA for Paris and modified Paris classifications and low accuracy and IOA for lesion histopathology prediction. Revisions of these classifications are required to create a clinically useful risk stratification tool and enable eventual application of augmented intelligence tools.

Multicenter Real-world Experience of Upadacitinib in the Treatment of Crohn's Disease

BACKGROUND

Upadacitinib is a selective Janus kinase inhibitor approved for the management of ulcerative colitis and under evaluation for the management of Crohn's disease in phase 3 clinical trials.

AIMS

Our goal is to describe our real-world experience with upadacitinib in Crohn's disease.

METHODS

This is a two-center retrospective cohort study of adult patients with moderate to severe Crohn's disease on upadacitinib. The primary outcome was clinical response and remission as determined by stool frequency and abdominal pain scores. Secondary endpoints included endoscopic response and remission as determined by change in simple endoscopic score for Crohn's. Outcomes were assessed at three months after starting upadacitinib and at patients' most recent follow-up. We further evaluated adverse events and dose-related response.

RESULTS

A total of 45 Crohn's disease patients received upadacitinib and were included in the safety analysis. Thirty-six patients received upadacitinib for Crohn's disease, whereas 9 received it for inflammatory arthritis (n=8) or pyoderma (n=1). Thirty-three patients received upadacitinib for 3 months or longer and were included in the efficacy analysis. At 3-month follow up, 21 patients achieved clinical response (63.6%) and 9 achieved clinical remission (27.2%). At time of last follow-up, 23 patients had clinical response (69.7%), 10 achieved clinical remission (30.3%), and 4 (28.6%) achieved endoscopic remission. Adverse events occurred in 12 patients (26.7%). Two patients had a serious adverse event (4.5%) without associated mortality.

CONCLUSION

In this real-world cohort of highly refractory Crohn's disease patients, upadacitinib was effective in inducing remission and had an acceptable safety profile.

Clinical Course and Impact of Immune Checkpoint Inhibitor Colitis Resembling Microscopic Colitis

Background

Microscopic colitis (MC) is suspected to result from increased immune activity in gut mucosa. Immune checkpoint inhibitors (ICIs) treat cancer by activating the immune system, and further investigation is needed regarding their role in the development of MC.

Methods

A retrospective case series investigated cases of endoscopically and histologically confirmed MC developing after administration of ICIs. Clinical notes and medication administration records were reviewed for demographics, symptom duration, and treatment response.

Results

Nineteen cases of de novo MC were identified, with 95% of cases requiring steroid treatment, 53% presenting with hospitalization, and colitis-related mortality in 1 individual. Symptom onset occurred a median of 160 days after initiation of ICI therapy and 53 days after their most recent dose of therapy. Patients had a median of 125 days of symptoms, and ICI therapy was held in 70% of individuals due for treatment.

Conclusions

MC can develop after ICI administration, and presents with severe symptoms, often requiring hospitalization and steroid treatment. In certain individuals this can require a prolonged treatment course of steroid therapy or immunomodulators. Individuals developing diarrhea after ICI therapy warrant thorough workup including endoscopy and rapid treatment initiation given the disease severity observed in this series.

Comparison of Physical Fitness and Anthropometrical Profiles Among Brazilian Female Soccer National Teams From U15 to Senior Categories

ABSTRACT

Ramos, GP, Nakamura, FY, Penna, EM, Mendes, TT, Mahseredjian, F, Lima, AM, Garcia, ES, Prado, LS, and Coimbra, CC. Comparison of physical fitness and anthropometrical profiles among Brazilian female soccer national teams from U15 to senior categories. J Strength Cond Res 35(8): 2302-2308, 2021-This study aimed to compare anthropometric and physical fitness of Brazilian female national team soccer players from the U15 to senior categories, and to compare the physical performance between selected and nonselected players. Subjects included 231 athletes (U15, n = 46, U17, n = 49, U20, n = 98, and Senior, n = 38). Body mass, height, sum of skinfolds, squat jump (SJ), countermovement jump (CMJ), 20-m linear sprint, and Yo-Yo IR1 were assessed. The U15 players were shorter than all other groups (p < 0.01) and lighter than U20 players (p < 0.01). Regarding physical tests, Senior athletes presented higher SJ compared with U20, and both showed higher CMJ and SJ compared with the U15 and U17 (p < 0.05). Senior athletes were also faster than players of all other categories in 20-m sprint (p < 0.01) and covered the greatest distance in the Yo-Yo IR1 (p < 0.05). U20 were better in the Yo-Yo IR1 than the younger groups (p < 0.05). When comparing selected and nonselected players, no differences were identified in anthropometric measures (p > 0.05). However, selected players from U17, U20, and Senior teams showed better performance in Yo-Yo IR1 than nonselected ones (p < 0.05). Finally, selected senior athletes also presented higher CMJ and SJ than nonselected players (p < 0.05). These results suggest that, although there is a tendency for maintenance in anthropometric measures from the age of 15 years, there are substantial improvements in speed, lower-body power, and aerobic capacity from U20 age group. In addition, it seems that intermittent aerobic fitness contributes to the selection of players to international tournaments in national teams.

BMI1 maintains the Treg epigenomic landscape to prevent inflammatory bowel disease

FOXP3+ Tregs are expanded within the inflamed intestine of human Crohn's disease, yet FOXP3-mediated gene repression within these cells is lost. The polycomb repressive complexes play a role in FOXP3 target gene regulation, but deeper mechanistic insight is incomplete. We have now specifically identified the polycomb-repressive complex 1 (PRC1) family member, BMI1 in the regulation of a proinflammatory enhancer network in both human and murine Tregs. Using human Tregs and lamina propria T cells, we inferred PRC1 to regulate Crohn's associated gene networks through assays of chromatin accessibility. Conditional deletion of BMI1 in murine FOXP3+ cells led to systemic inflammation. BMI1-deficient Tregs beared a TH1/TH17-like phenotype as assessed by assays of genome wide transcription, chromatin accessibility and proteomic techniques. Finally, BMI1 mutant FOXP3+ cells did not suppress colitis in the adoptive transfer model of human inflammatory bowel disease. We propose that BMI1 plays an important role in enforcing Treg identity in vitro and in vivo. Loss of Treg identity via genetic or transient BMI1 depletion perturbs the epigenome and converts Tregs into Th1/Th17-like proinflammatory cells, a transition relevant to human Crohn's disease associated CD4+ T cells.

Use of Immune Checkpoint Inhibitors in Patients With Pre-established Inflammatory Bowel Diseases: Retrospective Case Series

The etiology of inflammatory bowel disease (IBD) has yet to be fully understood; however, it is thought to be a result of genetic, immunologic, and environmental factors, including changes in the gut microbiome.^1,2 Immune checkpoint inhibitors (ICI) have revolutionized treatment of advanced cancer. They activate the immune system by promoting cytotoxic T-cell survival and antitumor effects. A total of 7 ICIs currently are approved by the United States Food and Drug Administration, and target cytotoxic T lymphocyte-associated protein 4 (ipilimumab); anti-programmed cell death 1 (PD-1) (nivolumab, pembrolizumab, and cemiplimab), or anti-PD-ligand 1 (atezolizumab, durvalumab, and avelumab). However, by activating the immune system, these medications also can lead to off-target inflammation and autoimmunity, including ICI-induced colitis, which has been reported in up to 13.6% of patients.³.

Impact of Bariatric Surgery on the Long-term Disease Course of Inflammatory Bowel Disease

BACKGROUND

An association between inflammatory bowel disease (IBD) and obesity has been observed. Little is known about the effect of weight loss on IBD course. Our aim was to determine the impact of bariatric surgery on long-term clinical course of obese patients with IBD, either Crohn's disease (CD) or ulcerative colitis (UC).

METHODS

Patients with IBD who underwent bariatric surgery subsequent to IBD diagnosis were identified from 2 tertiary IBD centers. Complications after bariatric surgery were recorded. Patients were matched 1:1 for age, sex, IBD subtype, phenotype, and location to patients with IBD who did not undergo bariatric surgery. Controls started follow-up at a time point in their disease similar to the disease duration in the matched case at the time of bariatric surgery. Inflammatory bowel disease medication usage and disease-related complications (need for corticosteroids, hospitalizations, and surgeries) among cases and controls were compared.

RESULTS

Forty-seven patients met inclusion criteria. Appropriate matches were found for 25 cases. Median follow-up among cases (after bariatric surgery) and controls was 7.69 and 7.89 years, respectively. Median decrease in body mass index after bariatric surgery was 12.2. Rescue corticosteroid usage and IBD-related surgeries were numerically less common in cases than controls (24% vs 52%; odds ratio [OR], 0.36; 95% confidence interval [CI], 0.08-1.23; 12% vs 28%; OR, 0.2; 95% CI, 0.004-1.79). Two cases and 1 control were able to discontinue biologics during follow-up.

CONCLUSIONS

Inflammatory bowel disease patients with weight loss after bariatric surgery had fewer IBD-related complications compared with matched controls. This observation requires validation in a prospective study design.

Activity Profiles in U17, U20, and Senior Women's Brazilian National Soccer Teams During International Competitions: Are There Meaningful Differences?

Ramos, GP, Nakamura, FY, Penna, EM, Wilke, CF, Pereira, LA, Loturco, I, Capelli, L, Mahseredjian, F, Silami-Garcia, E, and Coimbra, CC. Activity profiles in U17, U20, and senior women's Brazilian national soccer teams during international competitions: are there meaningful differences? J Strength Cond Res 33(12): 3414-3422, 2019-The aim of this study was to compare locomotor activity profiles of Brazilian top-class female soccer players competing at distinct age brackets (under 17 [U17], under [U20], and senior). External match load of 14 U17, 14 U20, and 17 senior female soccer players competing in 6-7 full official international matches were assessed using global positioning systems. Total distance covered, distance covered in high intensity (15.6-20 km·h), distance covered in sprints (sprint: >20 km·h), number of accelerations (Acc) >1 m·s, decelerations (Dec) >-1 m·s, and Player Load generally increased across the age brackets (U17 <U20 <senior). For all playing positions, senior athletes presented greater total distance, accelerations, and decelerations than U20 players. For high-intensity distance and sprints, only central defender and midfielder senior players presented greater values than U20 players. Senior players demonstrated higher values in all locomotor activities in comparison to U17 players, irrespective of playing positions. Except for central defenders who presented similar total distance, sprint distance, and number of accelerations between U20 and U17, most match external loads evaluated in all playing positions were greater in U20 than in U17 players. These results provide useful information for player development and should be used to establish appropriate match-specific conditioning drills according to age categories.

Outcomes of Treatment for Latent Tuberculosis Infection in Patients With Inflammatory Bowel Disease Receiving Biologic Therapy

BACKGROUND

Treatment for latent tuberculosis infection (LTBI) is of particular concern in patients with inflammatory bowel disease (IBD) initiating biologic therapies to prevent tuberculosis (TB) reactivation. This study aimed to evaluate the effectiveness of LTBI treatment in IBD patients receiving biologic therapy.

METHODS

There was a retrospective review of all IBD patients diagnosed with LTBI following a tuberculin skin test (TST) and/or interferon gamma release assay (IGRA) and who received biologic therapy between 2002 and 2016. The primary outcome was tuberculosis reactivation after completion of LTBI treatment.

RESULTS

Three-hundred twenty-nine IBD patients were identified, and 35 (27 Crohn's disease; 8 ulcerative colitis) met the study inclusion criteria. The mean age was 38.3 years, and 68.6% were male. The most common LTBI treatment regimen was isoniazid (INH) for 9 months (74%). Biologic therapies used were infliximab (40%), adalimumab (29%), vedolizumab (20%), and certolizumab pegol (11%). Combination therapy with an immunomodulator was administered in 57% of cases. The median time from initiation of LTBI treatment to biologics was 43 days. The mean duration of follow-up was 2.9 years. The estimated median annual risk of TB reactivation without treatment was 0.52% by a prediction formula. Only 1 patient taking adalimumab monotherapy developed reactivation of TB several years after completing 6 months of isoniazid therapy. The estimated TB reactivation rate was 0.98 cases per 100 patient-years of follow-up in our cohort.

CONCLUSIONS

Treatment for LTBI in patients with IBD treated with biologics is effective but does not eliminate the risk of reactivation. 10.1093/ibd/izy133_video1izy133.video15776720675001.

Gastrointestinal Bleeding Secondary to Iliac Artery Pseudoaneurysm in a Patient With Remote Pancreas Transplant: A Case Report

BACKGROUND

Vascular complications represent the most common cause of early graft failure after pancreatic transplantation (PT). Pseudoaneurysms are uncommon vascular complications that usually present within the first year post transplantation.

CASE REPORT

A 49-year-old man with history of type 1 diabetes mellitus presented for evaluation with a 2-day history of painless hematochezia. He had undergone PT 4 years prior to presentation, which failed due to acute cellular rejection after 1 year. Both extended upper endoscopy and colonoscopy did not identify an active bleeding source. After an episode of massive hematochezia, he became hemodynamically unstable with peritoneal signs noted on physical examination. An abdominal angiogram was unable to identify active hemorrhage, and the patient was transferred to the operating room for open laparotomy. Exploration revealed a right common iliac artery pseudoaneurysm eroding into the pancreatic-ileal anastomosis, which required initial digital compression for initial hemostasis. After combined endovascular procedure with ballooning and stenting of the right iliac artery, optimal hemostasis was achieved without further episodes of hematochezia.

DISCUSSION

Gastrointestinal bleeding (GIB) has been reported to occur in 11% of enteric-drained PT. Even though infectious causes have been reported, culprits are more commonly associated with vascular or enteric surgical anastomosis and usually occur within the early postoperative course. Here we report an uncommon cause of GIB, a late complication of PT, and review important points associated with the management of GIB, anatomy of PT, and potential etiologies for early and late GIB in the setting of PT.

De-novo Inflammatory Bowel Disease After Bariatric Surgery: A Large Case Series

BACKGROUND

Case reports of inflammatory bowel diseases [IBD] have been reported in patients with a history of bariatric surgery. Our aim was to characterize patients who were diagnosed with IBD after having undergone bariatric surgery.

METHODS

Electronic medical records were reviewed at two institutions to identify patients who developed de-novo Crohn's disease or ulcerative colitis [UC] after bariatric surgery. Data on demographics, type of bariatric surgical procedure, IBD subtype, phenotype and medication usage were obtained. The incidence rate of de-novo IBD after bariatric surgery [per 100000 person-years] and standardized incidence ratio [SIR] were estimated from a prospective bariatric surgery database.

RESULTS

A total of 44 patients with de-novo IBD after bariatric surgery were identified [31 Crohn's disease, 12 UC, one IBD unclassified]. Most patients were female [88.6%], with median age at IBD onset of 44 years [IQR, 37-52] and median time to IBD diagnosis after bariatric surgery of 7 years [IQR, 3-10]. Sixty-eight per cent underwent Roux-en-Y gastric bypass. In the prospective database, the incidence of IBD in patients who underwent bariatric surgery was 26.7 per 100000 person-years [4.5 for UC and 22.3 for Crohn's disease]. The age-adjusted SIR ranged from 3.56 in the 40-49 year age group to 4.73 in the 30-39 year age group.

CONCLUSION

We described a case series of patients developing de-novo IBD after bariatric surgery. There appears to be a numerically higher incidence of Crohn's disease in this population. Confirmation of causality is required in larger patient cohorts.

Evaluation of hydration status by urine, body mass variation and plasma parameters during an official half-marathon

BACKGROUND

The aim of this study was to verify the agreement of urine, body mass variations and plasma parameters to determine the hydration status of 14 male runners (29±4 years and 54.3±5.5 mLO2/kg/min) in an official 21.1 km road race.

METHODS

The mean dry-bulb temperature and air relative humidity during the road race were 25.1±2.1 °C and 54.7±2.2%, respectively. The volume of water ingested by the runners was monitored using marked volumetric plastic bottles provided at the hydration stations located at 0, 2.5, 5.0, 7.5, 10.5, 14.0, 16.0 and 18.5 km from the starting line. Hydration status was assessed using urine specific gravity (USG), urine osmolality (UOSM) and plasma osmolality (POSM). Furthermore, body mass variation (∆BM) was assessed by comparing body mass (BM) immediately prior and after the race. Total sweat was estimated by ∆BM, added water volume ingested and deducted blood volume collected. The sweat rate was calculated through total sweat and total exercise time.

RESULTS

The mean water intake was 0.82±0.40 L, and the mean sweat rate and total sweating were 1440.11±182.13 mL/h and 2.67±0.23 L. After the race, the BM reduced by 1.7±0.4 kg. The ∆BM was -2.41±0.47%, and the plasma volume variation was -9.79±4.6% between pre- and post-running measurements. Despite the POSM increased post-race compared to pre-race, the UOSM and USG did not change. No significant correlations were found between POSM variation with UOSM variation (r=-0.08; P=0.71), USG variation (r=-0.11; P=0.78) or ∆BM (r=0.09; P=0.77).

CONCLUSIONS

In conclusion, this study shows that both ∆BM and ∆POSM indicated a hypohydration state after exercise even though the ∆BM did not correlate significantly with ∆POSM. These results demonstrate that ∆BM is a practical method and can be sufficiently sensitive to evaluate the hydration state, but it should be utilized with caution.

Mannose-Binding Lectin Does Not Act as a Biomarker for the Progression of Preinvasive Lesions of Invasive Cervical Cancer

OBJECTIVE

To evaluate serum concentrations of mannose-binding lectin (MBL) in women presenting with different human papillomavirus (HPV)-associated cervical lesions.

SUBJECTS AND METHODS

A total of 364 women, who underwent screening for cervical cancer or treatment at the Erasto Gaertner Cancer Hospital (HEG), Curitiba, Brazil, were enrolled in the study. Based on the latest cervical colposcopy-guided biopsy results, the women were divided into 4 groups: cervical intraepithelial neoplasia CIN-I (n = 54), CIN-II (n = 72), CIN-III (n = 145), and invasive cancer (n = 93). A time-resolved immunofluorometric assay was used to measure the MBL concentrations in serum. The statistical analysis was done using GraphPad Prism 6.0. Comparisons were performed by Kruskal-Wallis and Mann-Whitney tests and analyzed by χ2 test; continuous variables are presented as medians and categorical variables as frequencies.

RESULTS

The median MBL concentrations in decreasing order were as follows: invasive cancer: 1,452 ng/mL, CIN-I: 1,324 ng/mL, CIN-II: 1,104 ng/mL, and CIN-III 1,098 ng/mL. However, no statistical significance was found among the 4 groups with HPV-associated lesions (p = 0.11). Equally, the MBL levels did not show a significant association between the age of the patients and the severity of the cervical lesions (p = 0.68). No statistical significance was found in the median values of MBL or in the status of MBL deficient (<100 ng/mL) and high producers (>1,000 ng/mL) among the women in each group (p = 0.77).

CONCLUSION

In this study, there was no statistically significant difference in MBL serum levels among the groups with CIN. Hence MBL serum concentration appeared not to have influenced the progression of HPV-related preinvasive cervical lesions into invasive cancer.

Metabolic Demand and Internal Training Load in Technical-Tactical Training Sessions of Professional Futsal Players

Wilke, CF, Ramos, GP, Pacheco, DAS, Santos, WHM, Diniz, MSL, Gonçalves, GGP, Marins, JCB, Wanner, SP, and Silami-Garcia, E. Metabolic demand and internal training load in technical-tactical training sessions of professional futsal players. J Strength Cond Res 30(8): 2330-2340, 2016-The aim of the study was to characterize aspects of technical-tactical training sessions of a professional futsal team. We addressed 4 specific aims: characterize the metabolic demands and intensity of these training sessions, compare the training intensity among players of different positions, compare the intensity of different futsal-specific activities (4 × 4, 6 × 4, and match simulation), and investigate the association between an objective (training impulse; TRIMP) and a subjective method (session rating of perceived exertion; sRPE) of measuring a player's internal training load. Twelve top-level futsal players performed an incremental exercise to determine their maximal oxygen consumption, maximal heart rate (HRmax), ventilatory threshold (VT), and respiratory compensation point (RCP). Each player's HR and RPE were measured and used to calculate energy expenditure, TRIMP, and sRPE during 37 training sessions over 8 weeks. The average intensity was 74 ± 4% of HRmax, which corresponded to 9.3 kcal·min. The players trained at intensities above the RCP, between the RCP and VT and below the VT for 20 ± 8%, 28 ± 6%, and 51 ± 10% of the session duration, respectively. Wingers, defenders, and pivots exercised at a similar average intensity but with different intensity distributions. No difference in intensity was found between the 3 typical activities. A strong correlation between the average daily TRIMP and sRPE was observed; however, this relationship was significant for only 4 of 12 players, indicating that sRPE is a useful tool for monitoring training loads but that it should be interpreted for each player individually rather than collectively.

The temperature of water ingested ad libitum does not influence performance during a 40-km self-paced cycling trial in the heat

AIM

The aim of the present study was to evaluate the effects of the temperature of ingested water on performance during a 40-km self-paced cycling trial in the heat (35º C and 60% relative humidity).

METHODS

The study was randomized, counterbalanced, crossover and single-blinded. Ten well-trained male cycling athletes (cyclists, mountain bikers or triathletes) who were non-acclimatized to heat were subjected to four experimental situations divided into two sets. In the first set, the participants performed two trials, during which they were given either cold (10º C) or warm water (37º C) ad libitum. In these situations, the volume and timing of the water ingestion (when each bolus was ingested) were recorded and replicated in the second set, but the water temperature was reversed.

RESULTS

The performance times were unaffected by the water intake volume (P=0.425), but the water at a temperature of 37º C tended to induce lower performance times (P=0.078) during the trials (AL10=93.0±3.5 min; AL37=94.4±4.1 min; SC10=93.4±4.0; SC37=97.4±4.3 min). The water intake was greater when the water was cold (P<0.05), but the temperature did not affect the heat storage rate, rectal temperature, mean skin temperature, heart rate, blood glucose level, sweat loss, sweat rate, perceived exertion rate or plasma volume changes. However, a significant reduction in the plasma volume change from pre- to postexercise was observed (P<0.01).

CONCLUSION

The performance, thermoregulatory, cardiovascular and metabolic responses during a 40-km self-paced cycling trial in the heat were unaffected by different water temperatures.

Physical performance and environmental conditions: 2014 World Soccer Cup and 2016 Summer Olympics in Brazil

This editorial is for the special issue “Temperature sciences in Brazil” of the journal Temperature. It focuses on the physical performance and environmental conditions during the 2014 World Cup and the coming 2016 Summer Olympics. It emphasizes that a hot and humid environment imposes a great challenge to the human thermoregulation system, can lead to performance decrements, and increases the risk of developing hyperthermia. Adequate hydration, acclimatization, and body cooling strategies are effective interventions to minimize the risks associated with exercise in the heat.

Seasonal humidity may influence Pseudomonas aeruginosa hospital-acquired infection rates

OBJECTIVE

The objective of this study was to determine the association of seasonal climatic conditions with the incidence of Pseudomonas aeruginosa infections.

METHODS

A retrospective study was carried out to evaluate all infections caused by P. aeruginosa in a 660-bed tertiary-care hospital in Brazil over a period of 5 years. To assess seasonal patterns, monthly temperature, relative humidity, and precipitation averages were obtained. Correlations of seasonal variations with infection rates (IR) were determined by Pearson correlation coefficient. Linear regression was used to determine trends, and multivariable linear regression was performed using a Poisson distribution.

RESULTS

A total of 844 cases of P. aeruginosa infection were identified for 1 058 501 patient-days during 1826 days (overall IR 7.97/10 000 patient-days). The mean temperature was 18.2±2.8°C, relative humidity was 80.3±3.6%, and precipitation was 104.7±64.38mm. The Pearson correlation was significant between urinary tract infection and temperature (R=0.29; p=0.021) and precipitation (R=0.27; p=0.036). A correlation was also significant between hospital-associated pneumonia and precipitation (R=0.29; p=0.022) and relative humidity (R=0.31; p=0.013). Relative humidity was associated with a higher IR of other infections caused by P. aeruginosa, but it was not possible to build a predictive model when multiple linear regression and Poisson regression were tested.

CONCLUSION

Climatic conditions are another factor that may interfere with the IR of Pseudomonas aeruginosa.