scholarly journals Social and health factors associated with unfavourable treatment outcome in adolescents and young adults with tuberculosis in Brazil: a national retrospective cohort study

2021 ◽  
Vol 9 (10) ◽  
pp. e1380-e1390 ◽  
Author(s):  
Louisa Chenciner ◽  
Kristi Sidney Annerstedt ◽  
Julia M Pescarini ◽  
Tom Wingfield
Keyword(s):  
Young Adults ◽  
Cohort Study ◽  
Treatment Outcome ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Adolescents And Young Adults ◽  
Factors Associated ◽  
Health Factors

scholarly journals 1342. Impact of HIV Infection on Treatment Outcome of New Tuberculosis Patients Attending Tuberculosis and Antiretroviral Treatment Services in the Community-Based Hospital, Thailand: A Retrospective Cohort Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S485-S486
Author(s):  
Subencha Pinsai
Keyword(s):  
Cohort Study ◽  
Treatment Outcome ◽  
Hiv Infection ◽  
Success Rate ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Treatment Success ◽  
Treatment Success Rate ◽  
Factors Associated ◽  
The Impact

Abstract Background Tuberculosis (TB) and HIV are one of the significant public health problems in Thailand, and an estimated 15,000 individuals have a dual infection. Both HIV and TB each disease speeds up the progression of each other. TB is the leading cause of death in HIV-infected individuals, and HIV coinfected TB patients have disease-specific, and treatment affected their treatment outcomes. There is insufficient evidence on issues of TB and HIV co-infection patients received treatment. This study aimed to assess the impact of HIV status on treatment outcome of TB patients. Methods We conducted a retrospective cohort study among TB patients who registered to service at Chaophraya Abhaibhubejhr Hospital, Prachin Buri, Thailand from October 1, 2017 to October 31, 2018. All patients’ demographic data, diagnosis, and treatment were retrieved. Clinical characteristics, treatment outcome, and factors associated with treatment outcome were analyzed. Results There were 49 (10.65%) HIV among 460 TB patients with a median (IQR) age of 44 (32–61) years old and 65.2% were males. Disseminated TB and extrapulmonary TB were higher in HIV coinfected group (P < 0.001). All pulmonary TB patients’ lower lobe involvement was higher in HIV coinfected group (62.50 vs. 36.00, P = 0.001). In HIV coinfected group median CD4 was 134 cell/mm3 (IQR 19–294), 66.67% were diagnosed HIV infection after TB diagnosis, the median time from TB diagnosed to antiretroviral was 29 days (IQR 21–48). The overall treatment success rate was 93.04%; the treatment success rate was similar in HIV coinfected TB patients (89.80%) and non- HIV-infected patients (93.43%) (P = 0.66).Adverse drug reactions were higher in HIV coinfected group (44.89% vs 12.41%) (P < 0.001). By multiple stepwise logistic regression, factors associated with anti-TB drug adverse reactions were having HIV infection (OR 7.99; 95% CI 3.73–17.10, P < 0.001), Age >60 years (OR 2.64; 95% CI 1.43–4.87, P = 0.002) and female sex (OR 1.97; 95% CI 1.11–3.52, P = 0.02). Conclusion There is a high TB treatment success rate among patients who have treated for TB, but adverse drug events in HIV co-infected TB patients is higher than that observed in non-HIV-infected patients. Disclosures All authors: No reported disclosures.

scholarly journals Prescribing of Long-term Antibiotics to Adolescents in Primary Care: a Retrospective Cohort Study

2021 ◽  
pp. BJGP.2021.0332
Author(s):  
Mark Lown ◽  
Sam McKeown ◽  
Beth Stuart ◽  
Nick Francis ◽  
Miriam Santer ◽  
...  
Keyword(s):  
Primary Care ◽  
Young Adults ◽  
Cohort Study ◽  
Antimicrobial Resistance ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Antibiotic Prescription ◽  
Adolescents And Young Adults ◽  
Antibiotic Prescribing

Background: Antibiotic overuse is linked with increased risk of antimicrobial resistance. Long-term antibiotics are commonly used for treating acne and prophylaxis of urinary tract infection. Their contribution to the overall burden of antibiotic use is relatively unknown. Aim: To describe the volume of commonly prescribed long-term (>= 28 days) antibiotic prescriptions in adolescents and young adults, trends over time and comparisons with acute prescriptions. Design and Setting: Retrospective cohort study using UK electronic primary care records. Methods: Patients born between 1979 and 1996 in the Care and Health Information Analytics database were included. Our main outcome measures were antibiotic prescription rates per 1000 person years, antibiotic prescription days per person year between ages 11-21. Results: 320,722 participants received a total of 710,803 antibiotic prescriptions between the ages of 11-21 from 1998 to 2017. 191,443/710,803 (26.93%) prescriptions were for long-term antibiotics (≥28 days and ≤ 6 months in duration). Long-term antibiotics accounted for more than two-thirds (72.48%) of total antibiotic exposure (days per person year). Total long-term antibiotic prescribing peaked in 2013 at just under 6 days per person year and declined to around 4 in 2017. Conclusions: Amongst adolescents and young adults, exposure to long-term antibiotics (primarily lymecycline used for acne) was much greater than for acute antibiotics and is likely to make an important contribution to antimicrobial resistance. Urgent action is needed to reduce unnecessary exposure to long-term antibiotics in this group. Increasing the use of and adherence to effective, non-antibiotic treatments for acne is key to achieving this.

scholarly journals Factors Associated With Treatment Outcome in Patients With Nontuberculous Mycobacterial Pulmonary Disease: a Large Population-based Retrospective Cohort Study in Shanghai

2021 ◽  
Author(s):  
Li Ping Cheng ◽  
Shan Hao Chen ◽  
Hai Lou ◽  
Xu Wei Gui ◽  
Xiao Na Shen ◽  
...  
Keyword(s):  
Cohort Study ◽  
Treatment Outcome ◽  
Treatment Failure ◽  
Pulmonary Disease ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Bacterial Species ◽  
Treatment Success ◽  
Middle Aged ◽  
Factors Associated

Abstract Background: Investigate factors associated with treatment outcome in patients with nontuberculous mycobacterial pulmonary disease (NTMPD). Methods: This retrospective cohort study examined NTMPD patients in Shanghai from January 2014 to December 2018. The distribution and incidence of the different causative species were determined. The outcomes of patients infected with different NTM species were compared. Univariate and multivariate binary logistic regression analyses were used to determine the odds ratios (ORs) and 95% confidence intervals (CIs) for the association of different factors with treatment failure. Results: The most common species were Mycobacterium avium complex (MAC) (50%), M. abscessus (28%), and M. kansasii (15%). Over five years, the proportions of M. kansasii and M. abscessus increased, and that of MAC decreased. The treatment success rate was significantly greater for patients infected with M. kansasii (89.9%) than MAC (65.0%, P<0.001) and M. abscessus (36.1%, P<0.001). Multivariate analysis indicated the risk factors for treatment failure were pathogenic NTM species (M. abscessus: aOR=9.355, P<0.001; MAC: aOR=2.970, P=0.021), having an elevated ESR (>60mm/h: aOR=2.658, P<0.001), receipt of retreatment (aOR=2.074, P<0.001), middle-aged and elderly (>60 years-old: aOR=1.739, P=0.021; 45–60 years-old: aOR=1.661, P=0.034). Conclusions: The main bacterial species responsible for NTMPD infections in Shanghai were MAC, M. abscessus, and M. kansasii. Patients with M. kansasii infections had a higher rate of treatment success. Multiple factors including infection by M. abscessu or MAC, an elevated ESR, receiving retreatment, middle-aged and elderly were associated with treatment failure.

scholarly journals Characteristics, outcomes and risk factors for mortality of 522 167 patients hospitalised with COVID-19 in Brazil: a retrospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e049089
Author(s):  
Marcia C Castro ◽  
Susie Gurzenda ◽  
Eduardo Marques Macário ◽  
Giovanny Vinícius A França
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Cox Proportional Hazards ◽  
Secondary Outcome ◽  
Hospital Death ◽  
Factors Associated ◽  
Icu Admission ◽  
Hospitalised Patients

ObjectiveTo provide a comprehensive description of demographic, clinical and radiographic characteristics; treatment and case outcomes; and risk factors associated with in-hospital death of patients hospitalised with COVID-19 in Brazil.DesignRetrospective cohort study of hospitalised patients diagnosed with COVID-19.SettingData from all hospitals across Brazil.Participants522 167 hospitalised patients in Brazil by 14 December 2020 with severe acute respiratory illness, and a confirmed diagnosis for COVID-19.Primary and secondary outcome measuresPrevalence of symptoms and comorbidities was compared by clinical outcomes and intensive care unit (ICU) admission status. Survival was assessed using Kaplan Meier survival estimates. Risk factors associated with in-hospital death were evaluated with multivariable Cox proportional hazards regression.ResultsOf the 522 167 patients included in this study, 56.7% were discharged, 0.002% died of other causes, 30.7% died of causes associated with COVID-19 and 10.2% remained hospitalised. The median age of patients was 61 years (IQR, 47–73), and of non-survivors 71 years (IQR, 60–80); 292 570 patients (56.0%) were men. At least one comorbidity was present in 64.5% of patients and in 76.8% of non-survivors. From illness onset, the median times to hospital and ICU admission were 6 days (IQR, 3–9) and 7 days (IQR, 3–10), respectively; 15 days (IQR, 9–24) to death and 15 days (IQR, 11–20) to hospital discharge. Risk factors for in-hospital death included old age, Black/Brown ethnoracial self-classification, ICU admission, being male, living in the North and Northeast regions and various comorbidities. Age had the highest HRs of 5.51 (95% CI: 4.91 to 6.18) for patients≥80, compared with those ≤20.ConclusionsCharacteristics of patients and risk factors for in-hospital mortality highlight inequities of COVID-19 outcomes in Brazil. As the pandemic continues to unfold, targeted policies that address those inequities are needed to mitigate the unequal burden of COVID-19.

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