Colistin therapy for microbiologically documented multidrug-resistant Gram-negative bacterial infections: a retrospective cohort study of 258 patients

Abstract Background Short-term readmission is an important outcome reflecting the poor trajectory of sepsis survivors. The aim of this study was to identify the major risk factors for 30 day-readmission among patients with Gram-negative bacteremia. Methods Retrospective cohort study including all consecutive adults hospitalized in the medical departments in a referral hospital in Israel with Gram-negative bacteremia between 2011 to 2020, who were discharged alive. Predictors for 30-day readmission were investigated, considering death after discharge as a competing event. Cephalosporin resistance was our predictor of interest. Sub-distribution hazard ratios (HR) of the cumulative incidence function were investigated using the Fine and Gray multivariable competing-risk regression model. The prediction models were cross-validated using the k-fold method. Results Among 2,196 patients surviving hospitalization with Gram-negative bacteremia, the mean age was 70±16 years and 432 (19.6%) were readmitted within 30 days. Variables associated readmission hazards included were Arab ethnicity, active malignancy, conditions requiring immune-suppression, anxiolytics or hypnotics, anticoagulant or antiplatelet therapy, discharge with a nasogastric tube, higher pre-discharge heart rate, duration of antibiotic therapy during hospitalization and bacteremia caused by cephalosporin-resistant bacteria (HR 1.23, 95% CI 0.99-1.52). The area under the receiver-operating characteristics curve for this model was 75.5% (95% CI 71.3-79.1%). In secondary models, cephalosporin resistance and inappropriate empirical antibiotic treatment and lower pre-discharge albumin, were significantly associated with re-admission. Conclusion 30-day re-admissions among patients with Gram-negative bacteremia surviving the index admission are high. Readmission was related to comorbidities and infections caused by multidrug-resistant infections.

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Incidence of Kawasaki disease before and during the COVID-19 pandemic: a retrospective cohort study in Japan

BMJ Paediatrics Open ◽

10.1136/bmjpo-2021-001034 ◽

2021 ◽

Vol 5 (1) ◽

pp. e001034

Author(s):

Kyohei Iio ◽

Kousaku Matsubara ◽

Chisato Miyakoshi ◽

Kunitaka Ota ◽

Rika Yamaoka ◽

...

Keyword(s):

Cohort Study ◽

Kawasaki Disease ◽

Infectious Diseases ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Bacterial Infections ◽

Epidemiological Studies ◽

Primary Objective ◽

Temporal Association ◽

Difference In Difference

BackgroundEpidemiological studies in Kawasaki disease (KD) have suggested infectious aetiology. During the COVID-19 pandemic, measures for mitigating SARS-CoV-2 transmission also suppress the circulation of other contagious microorganisms. The primary objective is to compare the number and incidence of KD before and during the COVID-19 pandemic in Japan, and the secondary objective is to investigate temporal association between the KD epidemiology and activities of SARS-CoV-2 and other viral and bacterial infections.MethodsA retrospective cohort study was conducted between 2016 and 2020 in Kobe, Japan. We collected information of hospitalised KD children in Kobe. Child population was identified through the resident registry system. Activity of COVID-19 and 11 other infectious diseases was derived from a public health monitoring system. Monthly change of KD incidence was analysed using a difference-in-difference regression model.ResultsThroughout the study period, 1027 KD children were identified. KD had begun to decline in April 2020, coinciding with the beginning of the COVID-19 pandemic. The number of KD cases (n=66) between April and December 2020 was 40% of the average in the same period in 2016–2019 (165/year). Annual KD incidence was 315, 300, 353, 347 and 188/100 000 children aged 0–4 years in 2016–2020, respectively. The difference-in-difference value of KD incidence was significantly reduced in the fourth quarter in 2020 (−15.8, 95% CI −28.0 to −3.5), compared with that in 2016–2019. Sentinel surveillance showed a marked decrease of all infectious diseases except exanthema subitum after the beginning of the COVID-19 pandemic. There were 86 COVID-19 cases aged <10 years and no KD children associated with COVID-19.ConclusionThis study showed that the number and incidence of KD was dramatically reduced during the COVID-19 pandemic in Japan. This change was temporally associated with decreased activities of various infectious diseases other than COVID-19, supporting the hypothesis of infection-triggered pathogenesis in KD.

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