Antibiotic use during end-of-life care: A systematic literature review and meta-analysis

Abstract Background: We performed a systematic literature review and meta-analysis measuring the burden of antibiotic use during end-of-life (EOL) care. Methods: We searched PubMed, CINAHL (EBSCO platform), and Embase (Elsevier platform), through July 2019 for studies with the following inclusion criteria in the initial analysis: antibiotic use in the EOL care patients (advanced dementia, cancer, organ failure, frailty or multi-morbidity). If the number of patients in palliative care consultation (PCC) was available, antibiotic use data were pooled to compare the proportion of patients who received antibiotics under PCC compared to those not receiving PCC. Random-effect models were used to obtain pooled mean differences, and heterogeneity was assessed using the I2 value. Results: Overall, 72 studies met the inclusion criteria and were included in the final review: 22 EOL studies included only patients with cancer; 17 studies included only patients with advanced dementia; and 33 studies included “mixed populations” of EOL patients. Although few studies reported antibiotic using standard metrics (eg, days of therapy), 48 of 72 studies (66.7%) reported antibiotic use in >50% of all patients. When the 3 studies that evaluated antibiotic use in PCC were pooled together, patients under PCC was more likely to receive antibiotics compared to patients not under PCC (pooled odds ratio, 1.73; 95% CI, 1.02–2.93). Conclusions: Future studies are needed to evaluate the benefits and harms of using antibiotics for patients during EOL care in diverse patient populations.

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Antibiotic Use at the End-of-Life in Patients with Advanced Dementia: A Systematic Literature Review

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.627 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s120-s120

Author(s):

Alexandre Marra ◽

Mireia Puig-Asensio ◽

Eli Perencevich

Keyword(s):

Literature Review ◽

Cohort Studies ◽

End Of Life ◽

Systematic Literature Review ◽

End Of Life Care ◽

Final Analysis ◽

Antibiotic Use ◽

Life Care ◽

Advanced Dementia ◽

Days Of Therapy

Background: Improving the use of antibiotics across the care continuum will be necessary as we strive to protect our patients from antimicrobial resistance. One potential target for antimicrobial stewardship is during end-of-life care of patients with advanced dementia. We aimed to perform a systematic literature review measuring the burden of antibiotic use during end-of-life care in patients with dementia. Methods: We searched PubMed, CINAHL, and Embase through July 2019 for studies with the following inclusion criteria in the initial analysis: (1) end-of-life patients (ie, dementia, cancer, organ failure, frailty or multi-morbidity); (2) antibiotic use in the end-of-life care; with the final analysis restricted to (3) patients with advanced dementia. Only randomized controlled trials (RCTs) and cohort studies were included. Results: Of the 93 full-text articles, 17 studies (18.3%) met the selection criteria for further analysis. Most of the included studies were retrospective (n = 8) or prospective (n = 8) cohort studies. These studies in combination included 2,501 patients with advanced dementia. Also, 5 studies (698 patients, [27.9%]) were restricted to patients with Alzheimer’s disease. In 5 studies in which data were available, fewer than one-quarter of patients (19.9%, 498) with advanced dementia were referred to palliative care. In 12 studies >50% of patients received antibiotics during the end-of-life period. Also, 15 studies did not report the duration of antimicrobial therapy. Only 2 studies reported the antimicrobial consumption in days of therapy per 1,000 resident days. Only 6 studies studied whether the use of antibiotics was associated with beneficial outcomes (survival or comfort), and none of them evaluated potential adverse effects associated with antibiotic use. Conclusions: There are significant gaps in the literature surrounding antimicrobial use at the end of life in patients with advanced dementia. Future studies are needed to evaluate the benefits and harms of using antibiotics for patients during end-of-life care in this patient population.Acknowledgement. We thank Jennifer Deberg from Hardin Library for the Health Sciences, University of Iowa Libraries on the search methods.Disclosures: NoneFunding: None

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Impact of Infectious Disease Consultation in Patients With Candidemia: A Retrospective Study, Systematic Literature Review, and Meta-analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa270 ◽

2020 ◽

Vol 7 (9) ◽

Author(s):

Takaaki Kobayashi ◽

Alexandre R Marra ◽

Marin L Schweizer ◽

Patrick Ten Eyck ◽

Chaorong Wu ◽

...

Keyword(s):

Infectious Disease ◽

Literature Review ◽

Systematic Literature Review ◽

Meta Analysis ◽

Tertiary Care ◽

Care Hospital ◽

Inclusion Criteria ◽

Infectious Disease Consultation ◽

Significant Difference ◽

The Impact

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Non-lesional treatment options for tremor in idiopathic Parkinson syndrome: a protocol for a systematic literature review

BMJ Open ◽

10.1136/bmjopen-2020-048367 ◽

2021 ◽

Vol 11 (8) ◽

pp. e048367

Author(s):

Anna Julia Pedrosa Carrasco ◽

Felicitas Mügge ◽

David José Pedrosa

Keyword(s):

Literature Review ◽

Systematic Literature Review ◽

Meta Analysis ◽

Treatment Options ◽

Inclusion Criteria ◽

Parkinson Syndrome ◽

Registration Number ◽

Future Publication ◽

Rich Data ◽

Improve Patient

IntroductionIdiopathic Parkinson syndrome (iPS) is one of the most common neurodegenerative disorders characterised by the triad of bradykinesia, rigidity and tremor. Tremor at rest predominantly at one side is often perceived by patients as severely disabling and yet ranges among the most difficult symptoms to treat. In medically refractory cases, lesional approaches have proven to be effective alternatives. However, to date, there is no comprehensive analysis of non-surgical therapies to manage iPS-patients’ tremor. We therefore present a detailed study protocol for a systematic literature review assessing efficacy/effectiveness and safety of non-lesional treatments for tremor in iPS.Methods and analysisWe will search three electronic databases (MEDLINE, EMBASE and PsycINFO) using a combination of title/abstract keywords. Additionally, hand-searched reference and citation lists of key reviews identified through the search strategy will be screened. Eligible studies should investigate the efficacy/effectiveness and safety of therapeutic options for tremor in iPS excluding lesional interventions. Publications will be independently assessed for inclusion criteria by two investigators and study information summarised using a standardised template including quality assessment according to the QualSyst tool. We will provide a narrative synthesis of results and conduct a meta-analysis whenever possible.Ethics and disseminationWe commit to present contemporary evidence on the efficacy/effectiveness and safety of non-lesional interventions for tremor in iPS in a future publication. We aim to compile rich data of published studies to inform healthcare professionals in order to ultimately improve patient outcomes.PROSPERO registration numberCRD42020202911).

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Presentation and Outcomes After Medical and Surgical Treatment Versus Medical Treatment Alone of Spontaneous Infectious Spondylodiscitis: A Systematic Literature Review and Meta-Analysis

Global Spine Journal ◽

10.1177/2192568218799058 ◽

2018 ◽

Vol 8 (4_suppl) ◽

pp. 49S-58S ◽

Cited By ~ 9

Author(s):

Davis G. Taylor ◽

Avery L. Buchholz ◽

Durga R. Sure ◽

Thomas J. Buell ◽

James H. Nguyen ◽

...

Keyword(s):

Back Pain ◽

Surgical Treatment ◽

Literature Review ◽

Medical Treatment ◽

Systematic Literature Review ◽

Meta Analysis ◽

Work Status ◽

Pyogenic Spondylodiscitis ◽

Neurologic Deficits ◽

Number Of Patients

Study Design: Systematic literature review. Objectives: The aims of this study were to (1) describe the clinical features, disabilities, and incidence of neurologic deficits of pyogenic spondylodiscitis prior to treatment and (2) compare the functional outcomes between patients who underwent medical treatment alone or in combination with surgery for pyogenic spondylodiscitis. Methods: A systematic literature review was performed using PubMed according to PRISMA guidelines. No year restriction was put in place. Statistical analysis of pooled data, when documented in the original report (ie, number of patients with desired variable and number of patients evaluated), was conducted to determine the most common presenting symptoms, incidence of pre- and postoperative neurologic deficits, associated comorbidities, infectious pathogens, approach for surgery when performed, and duration of hospitalization. Outcomes data, including return to work status, resolution of back pain, and functional recovery were also pooled among all studies and surgery-specific studies alone. Meta-analysis of studies with subgroup analysis of pain-free outcome in surgical and medical patients was performed. Results: Fifty of 1286 studies were included, comprising 4173 patients undergoing either medical treatment alone or in combination with surgery. Back pain was the most common presenting symptom, reported in 91% of patients. Neurologic deficit was noted in 31% of patients. Staphylococcus aureus was the most commonly reported pathogen, seen in 35% of reported cases. Decompression and fusion was the most commonly reported surgical procedure, performed in 80% of the surgically treated patients. Combined anterior-posterior procedures and staged surgeries were performed in 33% and 26% of surgeries, respectively. The meta-analysis comparing visual analog scale score at follow-up was superior among patients receiving surgery over medical treatment alone (mean difference −0.61, CI −0.90 to −0.25), while meta-analysis comparing freedom from pain in patients receiving medical treatment alone versus combined medical and surgical treatment demonstrated superior pain-free outcomes among surgical series (odds ratio 5.35, CI 2.27-12.60, P < .001), but was subject to heterogeneity among studies ( I2 = 56%, P = .13). Among all patients, freedom from pain was achieved in 79% of patients, and an excellent outcome was achieved in 73% of patients. Conclusion: Medical management remains first-line treatment of infectious pyogenic spondylodiscitis. Surgery may be indicated for progressive pain, persistent infection on imaging, deformity or neurologic deficits. If surgery is required, reported literature shows potential for significant pain reduction, improved neurologic function and a high number of patients returning to a normal functional/work status.

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The impact of smoking on prevalence of psoriasis and psoriatic arthritis

Rheumatology ◽

10.1093/rheumatology/keaa179 ◽

2020 ◽

Vol 59 (10) ◽

pp. 2695-2710 ◽

Cited By ~ 2

Author(s):

Ummugulsum Gazel ◽

Gizem Ayan ◽

Dilek Solmaz ◽

Servet Akar ◽

Sibel Z Aydin

Keyword(s):

Psoriatic Arthritis ◽

General Population ◽

Literature Review ◽

Systematic Literature Review ◽

Past History ◽

Meta Analysis ◽

Cochrane Central Register ◽

Central Register ◽

Number Of Patients ◽

The Impact

Abstract Objectives In this systematic literature review and meta-analysis, we aimed to investigate the impact of cigarette smoking on the prevalence and incidence of psoriasis and psoriatic arthritis (PsA). Method We performed a systematic literature review using the MEDLINE, EMBASE and Cochrane Central Register databases. The literature included publications from January 1980 to July 2019. The studies that provided clear information on the number of patients with ever smoking data were included in the meta-analysis. Results The systematic literature review identified 52 and 24 articles for the prevalence of smoking in psoriasis and PsA, respectively. Of these, 16 articles on psoriasis and three and four (general population and psoriasis, respectively) articles on PsA met the criteria and were included in the meta-analysis. The prevalence of ever smoking was increased in psoriasis compared with the general population (OR: 1.84; 95% CI: 1.4, 2.3). For PsA the prevalence of ever smoking was reduced in psoriasis patients (OR: 0.70; 95% CI: 0.60, 0.81), but not changed compared with the general population (OR: 1.10; 95% CI: 0.92, 1.32). Conclusion This meta-analysis showed that ever smoking increases the risk of psoriasis in the general population, but may reduce the risk of PsA in psoriasis patients. The latter may be also due to the collider effect. Whether smoking cessation neutralizes the risk of developing psoriasis requires a well-defined smoking data collection for the past history and this is currently unavailable in the literature.

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749. Impact of Infectious Disease Consultation in Patients with Candidemia: A Retrospective study, Systematic Literature Review and Meta-analysis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.939 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S421-S422

Author(s):

Takaaki Kobayashi ◽

Alexandre Marra ◽

Marin L Schweizer ◽

Patrick Ten Eyck ◽

Chaorong Wu ◽

...

Keyword(s):

Infectious Disease ◽

Literature Review ◽

Systematic Literature Review ◽

Meta Analysis ◽

Care Hospital ◽

Inclusion Criteria ◽

Research Support ◽

Infectious Disease Consultation ◽

The Impact ◽

Overall Mortality

Abstract Background Morbidity and mortality from candidemia remain unacceptably high. While infectious disease consultation (IDC) is known to lower the mortality from Staphylococcus aureus bacteremia, little is known on the impact of IDC in candidemia. Methods We conducted a retrospective observational cohort study of candidemia patients at a large tertiary care hospital between 2015 and 2019. All patients aged ≥18 years with blood cultures positive for Candida species were included. We only included the first episode of candidemia. Exclusion criteria were death or transfer to the palliative care unit within 48 hours from the time cultures became positive. The crude mortality rate was compared between those with IDC and without IDC. Then, we systematically searched five publication-databases through February 2020 and performed a meta-analysis of the impact of IDC on mortality of patients with candidemia. The study protocol has been submitted to the International Prospective Register for Systematic Reviews (PROSPERO) database (ID 156939) on April 2020. Results A total of 151 patients at our institution met the inclusion criteria, 129 (85%) of whom received IDC. Thirty-day, and 90-day mortality rates were significantly lower in the IDC group (18% vs 50%, P = .002; 23% vs 50%, P = .0022, respectively). Our systematic literature review returned 216 reports, of which, 13 studies including ours fulfilled the inclusion criteria. Among the 13 studies with a total 3687 patients, IDC was performed in 49% of patients. Mortality numbers were available in 10 studies. Overall mortality was 38.2% with a significant difference in favor of the IDC group (28.4% and 47.6%) with a pooled relative risk of 0.41 [95% Cl 0.35-0.49]. Ophthalmology referral (61%; 790/1279 and 21%; 273/1304, P < 0.001), echocardiogram (54%; 662/1219 and 28%; 369/1296, P < 0.001), and central line removal (78%; 830/1069 and 61%; 686/1116, P < 0.02) were performed more frequently among patients receiving IDC. Overall mortality Conclusion This study is the first systematic literature review and meta-analysis to evaluate the association between IDC and candidemia mortality. IDC was associated with a lower mortality and should be standard of care in all patients with candidemia. Disclosures Dimitrios Farmakiotis, MD, Astellas (Grant/Research Support) Paul Auwaerter, Collidion (Consultant)DiaSorin (Consultant)Johnson and Johnson (Shareholder)MicroB-Plex (Research Grant or Support)Shionogi (Consultant) Daniel Diekema, bioMerieux, Inc (Grant/Research Support)JMI Laboratories (Consultant)

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A Systematic Literature Review and Meta-Analysis of the Incidence of Serious or Severe Hypersensitivity Reactions after Administration of Ferric Derisomaltose and Ferric Carboxymaltose

Blood ◽

10.1182/blood-2021-148388 ◽

2021 ◽

Vol 138 (Supplement 1) ◽

pp. 4157-4157

Author(s):

Patrick Biggar ◽

Nicholas Kennedy ◽

Johannes Pöhlmann ◽

Richard F Pollock-Wilkins

Keyword(s):

Iron Deficiency ◽

Literature Review ◽

Systematic Literature Review ◽

Meta Analysis ◽

Deficiency Anemia ◽

Ferric Carboxymaltose ◽

Hypersensitivity Reactions ◽

Active Comparator ◽

Number Of Patients ◽

Iv Iron

Abstract Background and Aims Intravenous (IV) iron is the preferred treatment for patients with iron deficiency (ID) and iron deficiency anemia (IDA) in a variety of clinical situations. Although uncommon, administration of modern IV iron formulations can result in hypersensitivity reactions and, very rarely, anaphylactic reactions. The objective of the present study was to systematically review the literature to identify and analyze data on the incidence of serious or severe hypersensitivity reactions (HSRs) after administration of different IV iron formulations. Methods A prospectively-registered systematic literature review (SLR) was conducted to identify prospective, active comparator randomized controlled trials (RCTs) comparing ferric derisomaltose (FDI) (also known as iron isomaltoside 1000) or ferric carboxymaltose (FCM) with other IV iron formulations or oral iron. The primary endpoint was the incidence of serious or severe hypersensitivity reactions occurring on the day or day after dosing of IV iron, based on pre-specified terms (MedDRA classification). Results Data were obtained from ten prospective, active comparator RCTs of FDI (N=3,474) and seven prospective, active comparator RCTs of FCM (N=2,683), two of which were head-to-head comparisons of FDI and FCM. The trials enrolled a total of 10,467 patients, of whom 6,157 were treated with either FDI or FCM. The number of patients experiencing any serious or severe hypersensitivity reactions was 5/3474 with FDI (0.14%) versus 29/2683 (1.08%) with FCM; Bayesian inference of proportions showed the reaction rates to be significantly lower with FDI relative to FCM (Figure). Conclusions To our knowledge, the present analysis represents the first SLR and meta-analysis of the incidence of serious or severe HSRs after administration of FDI vs FCM based on pre-specified MedDRA terms. The SLR conducted for the present meta-analysis, identified 15 prospective, head-to-head RCTs including 10,467 patients, of whom 3,474 and 2,683 were treated with FDI and FCM, respectively. The analysis demonstrated that serious or severe hypersensitivity reactions were uncommon with the newer high-dose IV iron formulations; and showed a significantly lower incidence of serious or severe hypersensitivity reactions with FDI compared to FCM. Figure 1 Figure 1. Disclosures Biggar: Vifor-Fresenius: Consultancy; Pharmacosmos: Consultancy; Medice: Consultancy. Pöhlmann: Pharmacosmos A/S: Consultancy. Pollock-Wilkins: Pharmacosmos A/S: Consultancy.

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POS1078 CURRENT REGISTRIES IN PSA DO NOT WELL REFLECT THE PROFILES OF PATIENTS WITH PsA BECAUSE THEY ORIGINATE IN SIMILAR COUNTRIES: A SYSTEMATIC LITERATURE REVIEW OF 27 REGISTRIES, OR 16183 PATIENTS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3097 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 818.1-818

Author(s):

G. S. Moysidou ◽

K. Aouad ◽

A. Rakotozafiarison ◽

B. Fautrel ◽

L. Gossec

Keyword(s):

Systematic Review ◽

Psoriatic Arthritis ◽

Literature Review ◽

Diagnostic Criteria ◽

Systematic Literature Review ◽

Disease Duration ◽

Meta Analysis ◽

Weighted Mean ◽

Real World Data ◽

Number Of Patients

Background:Psoriatic arthritis (PsA) is a multidimensional inflammatory disease with a great geographic variability and a global average prevalence estimated at 133 every 100,000 subjects according to a recent systematic review and meta-analysis (1). Registries and cohorts reflect more closely real-world data than randomized controlled trials (RCTS) and may indicate ongoing interest of each country on PsA.Objectives:The purpose of this study is to assess how recent registries and PsA related cohorts reflect its worldwide prevalence.Methods:A systematic literature review was performed in Pubmed Medline (PROSPEROCRD42020175745) to identify all articles reporting on either registries or longitudinal cohorts in PsA, published between 2010 and March 2020. Registries centered on drugs or not PsA-specific, trials and long term extension studies were excluded. The data collection comprised registries’ and cohorts’ originating countries, patient characteristics and the clinical outcome measures reported. Statistics were descriptive.Results:Of 673 articles, 73 were relevant for analysis, corresponding to 27 registries or PsA specific cohorts, with the participation of 30 countries. The overall number of patients was 16,183 with a mean of 599 per study. Overall, 50.1% were men, weighted mean age was 50,6 years and weighted mean disease duration was 6.9 years.Most of the registries were based in Europe (67%) or North America (26%) whereas Africa was underrepresented (Figure 1). USA was the most represented country participating in 6 registries. Mean age and mean disease duration were shorter in international registries (Table 1). Caspar diagnostic criteria were the most frequently used, mainly in the national registries (86,4%), whereas the use of diagnostic criteria was more heterogenous in the international registries.Conclusion:Recent registries and PsA specific cohorts do not cover the worldwide spectrum of the disease.References:[1]Scotti L, Franchi M, Marchesoni A, Corrao G. Prevalence and incidence of psoriatic arthritis: A systematic review and meta-analysis. Semin Arthritis Rheum. 2018 Aug;48(1):28-34Table 1.Description of 27 ongoing PsA registries or PsA cohorts, comparing nationwide and international registriesNATIONWIDE REGISTRIES (N=22)INTERNATIONAL REGISTRIES (N=5)WOMEN (%) 49,4 50,8MEAN AGE, WEIGTHED (YEARS) 52,32 48,09MEAN DISEASE DURATION, WEIGHTED (YEARS) 8,59 5,86CASPAR DIAGNOSTIC CRITERIA (%) 86,4 40Figure 1.Geographical distribution of PsA registriesDisclosure of Interests:None declared.

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