Nosocomial transmission of sporadic Creutzfeldt-Jakob disease: results from a risk-based assessment of surgical interventions

OBJECTIVES: Evidence of surgical transmission of sporadic Creutzfeldt-Jakob disease (sCJD) remains debatable in part due to misclassification of exposure levels. In a registry-based case-control study, the authors applied a risk-based classification of surgical interventions to determine the associa...

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Autores: Pedro-Cuesta, Jesus de, Mahillo-Fernandez, Ignacio, Rábano, Alberto, Calero, Miguel, Cruz, Mabel, Siden, Ake, Laursen, Henning, Falkenhorst, Gerhard, Mølbak, Kåre
Tipo de documento: artigo
Data de publicação:2011
País:España
Recursos:Instituto de Salud Carlos III (ISCIII)
Repositório:Repisalud
Idioma:inglês
OAI Identifier:oai:repisalud.isciii.es:20.500.12105/7697
Acesso em linha:http://hdl.handle.net/20.500.12105/7697
Access Level:Acceso aberto
Palavra-chave:Case-Control Studies
Creutzfeldt-Jakob Syndrome
Cross Infection
Data Interpretation, Statistical
Denmark
Hospitals
Humans
Logistic Models
Odds Ratio
Ophthalmologic Surgical Procedures
Registries
Risk Assessment
Surgical Procedures, Operative
Sweden
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spelling Nosocomial transmission of sporadic Creutzfeldt-Jakob disease: results from a risk-based assessment of surgical interventionsPedro-Cuesta, Jesus deMahillo-Fernandez, IgnacioRábano, AlbertoCalero, MiguelCruz, MabelSiden, AkeLaursen, HenningFalkenhorst, GerhardMølbak, KåreCase-Control StudiesCreutzfeldt-Jakob SyndromeCross InfectionData Interpretation, StatisticalDenmarkHospitalsHumansLogistic ModelsOdds RatioOphthalmologic Surgical ProceduresRegistriesRisk AssessmentSurgical Procedures, OperativeSwedenOBJECTIVES: Evidence of surgical transmission of sporadic Creutzfeldt-Jakob disease (sCJD) remains debatable in part due to misclassification of exposure levels. In a registry-based case-control study, the authors applied a risk-based classification of surgical interventions to determine the association between a history of surgery and sCJD. DESIGN: Case-control study, allowing for detailed analysis according to time since exposure. SETTING: National populations of Denmark and Sweden. PARTICIPANTS: From national registries of Denmark and Sweden, the authors included 167 definite and probable sCJD cases with onset during the period 1987-2003, 835 age-, sex- and residence-matched controls and 2224 unmatched. Surgical procedures were categorised by anatomical structure and presumed risk of transmission level. The authors used logistic regression to determine the odds ratio (OR) for sCJD by surgical interventions in specified time-windows before disease-onset. RESULTS: From comparisons with matched controls, procedures involving retina and optic nerve were associated with an increased risk at a latency of ≥1 year OR (95% CI) 5.53 (1.08 to 28.0). At latencies of 10 to 19 years, interventions on peripheral nerves 4.41 (1.17 to 16.6) and skeletal muscle 1.58 (1.01 to 2.48) were directly associated. Interventions on blood vessels 4.54 (1.01 to 20.0), peritoneum 2.38 (1.14 to 4.96) and skeletal muscle 2.04 (1.06 to 3.92), interventions conducted by vaginal approach 2.26 (1.14 to 4.47) and a pooled category of lower-risk procedures 2.81 (1.62 to 4.88) had an increased risk after ≥20 years. Similar results were found when comparing with unmatched controls. INTERPRETATION: This observation is in concordance with animal models of prion neuroinvasion and is likely to represent a causal relation of surgery with a non-negligible proportion of sCJD cases.BMJ Publishing GroupFundación Centro De Investigación De Enfermedades NeurológicasCentro de Investigación Biomédica en Red - CIBERNED (Enfermedades Neurodegenerativas)Unión Europea. Comisión Europea20192019-05-3020112011-02-0120112011-02-01journal articlehttp://purl.org/coar/resource_type/c_6501VoRhttp://purl.org/coar/version/c_970fb48d4fbd8a85info:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/20.500.12105/7697reponame:Repisaludinstname:Instituto de Salud Carlos III (ISCIII)InglésengEC QLRG3-CT-2002-81223 Not availableES RECS PC03-09ES CIEN C03-06open accesshttp://purl.org/coar/access_right/c_abf2Atribución-NoComercial-CompartirIgual 4.0 Internacionalhttp://creativecommons.org/licenses/by-nc-sa/4.0/info:eu-repo/semantics/openAccessoai:repisalud.isciii.es:20.500.12105/76972026-06-12T12:43:37Z
dc.title.none.fl_str_mv Nosocomial transmission of sporadic Creutzfeldt-Jakob disease: results from a risk-based assessment of surgical interventions
title Nosocomial transmission of sporadic Creutzfeldt-Jakob disease: results from a risk-based assessment of surgical interventions
spellingShingle Nosocomial transmission of sporadic Creutzfeldt-Jakob disease: results from a risk-based assessment of surgical interventions
Pedro-Cuesta, Jesus de
Case-Control Studies
Creutzfeldt-Jakob Syndrome
Cross Infection
Data Interpretation, Statistical
Denmark
Hospitals
Humans
Logistic Models
Odds Ratio
Ophthalmologic Surgical Procedures
Registries
Risk Assessment
Surgical Procedures, Operative
Sweden
title_short Nosocomial transmission of sporadic Creutzfeldt-Jakob disease: results from a risk-based assessment of surgical interventions
title_full Nosocomial transmission of sporadic Creutzfeldt-Jakob disease: results from a risk-based assessment of surgical interventions
title_fullStr Nosocomial transmission of sporadic Creutzfeldt-Jakob disease: results from a risk-based assessment of surgical interventions
title_full_unstemmed Nosocomial transmission of sporadic Creutzfeldt-Jakob disease: results from a risk-based assessment of surgical interventions
title_sort Nosocomial transmission of sporadic Creutzfeldt-Jakob disease: results from a risk-based assessment of surgical interventions
dc.creator.none.fl_str_mv Pedro-Cuesta, Jesus de
Mahillo-Fernandez, Ignacio
Rábano, Alberto
Calero, Miguel
Cruz, Mabel
Siden, Ake
Laursen, Henning
Falkenhorst, Gerhard
Mølbak, Kåre
author Pedro-Cuesta, Jesus de
author_facet Pedro-Cuesta, Jesus de
Mahillo-Fernandez, Ignacio
Rábano, Alberto
Calero, Miguel
Cruz, Mabel
Siden, Ake
Laursen, Henning
Falkenhorst, Gerhard
Mølbak, Kåre
author_role author
author2 Mahillo-Fernandez, Ignacio
Rábano, Alberto
Calero, Miguel
Cruz, Mabel
Siden, Ake
Laursen, Henning
Falkenhorst, Gerhard
Mølbak, Kåre
author2_role author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Fundación Centro De Investigación De Enfermedades Neurológicas
Centro de Investigación Biomédica en Red - CIBERNED (Enfermedades Neurodegenerativas)
Unión Europea. Comisión Europea
dc.subject.none.fl_str_mv Case-Control Studies
Creutzfeldt-Jakob Syndrome
Cross Infection
Data Interpretation, Statistical
Denmark
Hospitals
Humans
Logistic Models
Odds Ratio
Ophthalmologic Surgical Procedures
Registries
Risk Assessment
Surgical Procedures, Operative
Sweden
topic Case-Control Studies
Creutzfeldt-Jakob Syndrome
Cross Infection
Data Interpretation, Statistical
Denmark
Hospitals
Humans
Logistic Models
Odds Ratio
Ophthalmologic Surgical Procedures
Registries
Risk Assessment
Surgical Procedures, Operative
Sweden
description OBJECTIVES: Evidence of surgical transmission of sporadic Creutzfeldt-Jakob disease (sCJD) remains debatable in part due to misclassification of exposure levels. In a registry-based case-control study, the authors applied a risk-based classification of surgical interventions to determine the association between a history of surgery and sCJD. DESIGN: Case-control study, allowing for detailed analysis according to time since exposure. SETTING: National populations of Denmark and Sweden. PARTICIPANTS: From national registries of Denmark and Sweden, the authors included 167 definite and probable sCJD cases with onset during the period 1987-2003, 835 age-, sex- and residence-matched controls and 2224 unmatched. Surgical procedures were categorised by anatomical structure and presumed risk of transmission level. The authors used logistic regression to determine the odds ratio (OR) for sCJD by surgical interventions in specified time-windows before disease-onset. RESULTS: From comparisons with matched controls, procedures involving retina and optic nerve were associated with an increased risk at a latency of ≥1 year OR (95% CI) 5.53 (1.08 to 28.0). At latencies of 10 to 19 years, interventions on peripheral nerves 4.41 (1.17 to 16.6) and skeletal muscle 1.58 (1.01 to 2.48) were directly associated. Interventions on blood vessels 4.54 (1.01 to 20.0), peritoneum 2.38 (1.14 to 4.96) and skeletal muscle 2.04 (1.06 to 3.92), interventions conducted by vaginal approach 2.26 (1.14 to 4.47) and a pooled category of lower-risk procedures 2.81 (1.62 to 4.88) had an increased risk after ≥20 years. Similar results were found when comparing with unmatched controls. INTERPRETATION: This observation is in concordance with animal models of prion neuroinvasion and is likely to represent a causal relation of surgery with a non-negligible proportion of sCJD cases.
publishDate 2011
dc.date.none.fl_str_mv 2011
2011-02-01
2011
2011-02-01
2019
2019-05-30
dc.type.none.fl_str_mv journal article
http://purl.org/coar/resource_type/c_6501
VoR
http://purl.org/coar/version/c_970fb48d4fbd8a85
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv http://hdl.handle.net/20.500.12105/7697
url http://hdl.handle.net/20.500.12105/7697
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.relation.none.fl_str_mv EC QLRG3-CT-2002-81223 Not available
ES RECS PC03-09
ES CIEN C03-06
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
Atribución-NoComercial-CompartirIgual 4.0 Internacional
http://creativecommons.org/licenses/by-nc-sa/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
Atribución-NoComercial-CompartirIgual 4.0 Internacional
http://creativecommons.org/licenses/by-nc-sa/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv BMJ Publishing Group
publisher.none.fl_str_mv BMJ Publishing Group
dc.source.none.fl_str_mv reponame:Repisalud
instname:Instituto de Salud Carlos III (ISCIII)
instname_str Instituto de Salud Carlos III (ISCIII)
reponame_str Repisalud
collection Repisalud
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,812429

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