scholarly journals Effect of delays in concordant antibiotic treatment on mortality in patients with hospital-acquired Acinetobacter spp. bacteremia in Thailand: a 13-year retrospective cohort

2020 ◽  
Vol 41 (S1) ◽  
pp. s184-s185
Author(s):  
Cherry Lim ◽  
Mo Yin ◽  
Prapit Teparrukkul ◽  
Maliwan Hongsuwan ◽  
Nicholas P.J. Day ◽  
...  
Keyword(s):  
Medical Research ◽  
Antibiotic Treatment ◽  
Research Council ◽  
Medical Research Council ◽  
Blood Collection ◽  
Absolute Increase ◽  
Immortal Time Bias ◽  
Training Fellowship ◽  
Hospital Acquired ◽  
The Impact

Background: A quantitative understanding of the impact of delays to concordant antibiotic treatment on patient mortality is important for designing hospital antibiotic policies. Acinetobacter spp are among the most prevalent pathogens causing multidrug-resistant hospital-acquired infections in developing countries. We aimed to determine the causal effect of delays in concordant antibiotic treatment on 30-day survival of patients with hospital-acquired Acinetobacter spp bacteremia in a resource-limited setting. Methods: We included patients with Acinetobacter spp–related hospital-acquired bacteremia (HAB) in a hospital in Thailand over a 13-year period. We classified patients into 4 groups: those with no delays to concordant antibiotic treatment; those with a 1-day delay; those with 2-day delays; and those with >2 days of delay. We adopted an analytical approach that aimed to emulate a randomized controlled trial and compared the expected potential outcomes of patients between the exposure groups using a marginal structural model with inverse-probability weightings to adjust for confounders and immortal time bias. Results: Between January 2003 and December 2015, 1,203 patients had HAB with Acinetobacter spp., of which 682 patients (56.7%) had ≥1 days of delay in concordant antibiotic treatment. These delays were associated with an absolute increase in 30-day mortality of 6.6% (95% CI 0.2%-13.0%), from 33.8% to 40.4%. Among the 1,203 patients, 521 had no delays to concordant antibiotic treatment (i.e. concordant therapy on the day of blood collection), 224 patients had a 1-day delay, 119 had a 2-day delay, and 339 had a delay of ≥3 days. The crude 30-day mortality was substantially lower in patients with ≥3 days of delay in concordant treatment compared to those with 1 to 2-days of delays. After adjusting for measured confounders and immortal time bias, the expected probability of dying in the hospital within 30-days of blood collection if patient had no delays in concordant therapy was 39.7% (95% CI: 32.3-47.2%), for a 1-day delay it was 42.7% (95% CI: 29.8-55.7%), for a 2-day delay it was 51.0% (95% CI: 38.9-63.2%), and for a ≥3 days was 40.9% (36.0-45.7%).Conclusions: Delays to concordant antibiotic therapy are linked to increased mortality among patients with HAB due to Acinetobacter spp. Accounting for confounders and immortal time bias is necessary when attempting to estimate causal effects of delayed concordant treatment and, in this case, it helped resolve paradoxical results in crude data.Funding: The Mahidol Oxford Tropical Medicine Research Unit (MORU) is funded by the Wellcome Trust [grant number 106698/Z14/Z]. CL is funded by a Wellcome Trust Research Training Fellowship [grant number 206736/Z/17/Z]. MY is supported by a Singapore National Medical Research Council Research Fellowship [grant number NMRC/Fellowship/0051/2017]. BSC is funded by the UK Medical Research Council and Department for International Development [grant number MR/K006924/1]. DL is funded by a Wellcome Trust Intermediate Training Fellowship [grant number 101103]. The funder has no role in the design and conduct of the study, data collection, or in the analysis and interpretation of the data.Disclosures: None

scholarly journals Effect of delays in concordant antibiotic treatment on mortality in patients with hospital-acquired Acinetobacter spp. bacteremia: a 13-year retrospective cohort

2020 ◽  
Author(s):  
Cherry Lim ◽  
Mo Yin ◽  
Prapit Teparrukkul ◽  
Maliwan Hongsuwan ◽  
Nicholas P.J. Day ◽  
...  
Keyword(s):  
Medical Research ◽  
Antibiotic Treatment ◽  
Research Council ◽  
Medical Research Council ◽  
Research Training ◽  
Absolute Increase ◽  
Immortal Time Bias ◽  
Training Fellowship ◽  
Hospital Acquired ◽  
The Impact

AbstractBackgroundTherapeutic options for multidrug-resistant Acinetobacter spp. are limited, and resistance to last resort antibiotics in hospitals is increasing globally. Quantifying the impact of delays in concordant antibiotic treatment on patient mortality is important for designing hospital antibiotic policies.MethodsWe included patients with Acinetobacter spp. hospital-acquired bacteremia (HAB) in a hospital in Thailand over a 13-year period. For each day of stay following the first positive blood culture we considered antibiotic treatment to be concordant if the isolated organism was susceptible to at least one antibiotic given. We used marginal structural models with inverse-probability weightings to determine the association between delays in concordant treatment and 30-day mortality.ResultsBetween January 2003 and December 2015, 1,203 patients had HAB with Acinetobacter spp., of which 682 patients (56.7%) had one or more days of delay in concordant treatment. These delays were associated with an absolute increase in 30-day mortality of 6.6% (95% CI 0.2%-13.0%), from 33.8% to 40.4%. Crude 30-day mortality was substantially lower in patients with three or more days of delays in concordant treatment compared to those with one to two days of delays. Accounting for confounders and immortal time bias resolved this paradox, and showed similar 30-day mortality for one, two and three or more days of delays.ConclusionsDelays in concordant antibiotic treatment were associated with a 6.6% absolute increase in mortality among patients with hospital-acquired Acinetobacter spp. bacteremia. If this association is causal, switching fifteen patients from discordant to concordant initial treatment would be expected to prevent one death.FundingThe Mahidol Oxford Tropical Medicine Research Unit (MORU) is funded by the Wellcome Trust [grant number 106698/Z14/Z]. CL is funded by a Wellcome Trust Research Training Fellowship [grant number 206736/Z/17/Z]. MY is supported by a Singapore National Medical Research Council Research Fellowship [grant number NMRC/Fellowship/0051/2017]. BSC is funded by the UK Medical Research Council and Department for International Development [grant number MR/K006924/1]. DL is funded by a Wellcome Trust Intermediate Training Fellowship [grant number 101103]. The funder has no role in the design and conduct of the study, data collection, or in the analysis and interpretation of the data.

scholarly journals The contribution of hospital-acquired infections to the COVID-19 epidemic in England in the first half of 2020

2021 ◽  
Author(s):  
Gwenan M. Knight ◽  
Thi Mui Pham ◽  
James Stimson ◽  
Sebastian Funk ◽  
Yalda Jafari ◽  
...  
Keyword(s):  
Medical Research ◽  
Symptom Onset ◽  
Research Council ◽  
Medical Research Council ◽  
National Level ◽  
Hospital Setting ◽  
Hospital Acquired Infections ◽  
Hospitalised Patients ◽  
Total Burden ◽  
Hospital Acquired

AbstractBackgroundSARS-CoV-2 spreads in hospitals, but the contribution of these settings to the overall COVID-19 burden at a national level is unknown.MethodsWe used comprehensive national English datasets and simulation modelling to determine the total burden (identified and unidentified) of symptomatic hospital-acquired infections. Those unidentified would either be 1) discharged before symptom onset (“missed”), or 2) have symptom onset 7 days or fewer from admission (“misclassified”). We estimated the contribution of “misclassified” cases and transmission from “missed” symptomatic infections to the English epidemic before 31st July 2020.FindingsIn our dataset of hospitalised COVID-19 patients in acute English Trusts with a recorded symptom onset date (n = 65,028), 7% were classified as hospital-acquired (with symptom onset 8 or more days after admission and before discharge). We estimated that only 30% (range across weeks and 200 simulations: 20-41%) of symptomatic hospital-acquired infections would be identified. Misclassified cases and onward transmission from missed infections could account for 15% (mean, 95% range over 200 simulations: 14·1%-15·8%) of cases currently classified as community-acquired COVID-19.From this, we estimated that 26,600 (25,900 to 27,700) individuals acquired a symptomatic SARS-CoV-2 infection in an acute Trust in England before 31st July 2020, resulting in 15,900 (15,200-16,400) or 20.1% (19.2%-20.7%) of all identified hospitalised COVID-19 cases.ConclusionsTransmission of SARS-CoV-2 to hospitalised patients likely caused approximately a fifth of identified cases of hospitalised COVID-19 in the “first wave”, but fewer than 1% of all SARS-CoV-2 infections in England. Using symptom onset as a detection method for hospital-acquired SARS-CoV-2 likely misses a substantial proportion (>60%) of hospital-acquired infections.FundingNational Institute for Health Research, UK Medical Research Council, Society for Laboratory Automation and Screening, UKRI, Wellcome Trust, Singapore National Medical Research Council.Research in contextEvidence before this studyWe searched PubMed with the terms “((national OR country) AND (contribution OR burden OR estimates) AND (“hospital-acquired” OR “hospital-associated” OR “nosocomial”)) AND Covid-19” for articles published in English up to July 1st 2021. This identified 42 studies, with no studies that had aimed to produce comprehensive national estimates of the contribution of hospital settings to the COVID-19 pandemic. Most studies focused on estimating seroprevalence or levels of infection in healthcare workers only, which were not our focus. Removing the initial national/country terms identified 120 studies, with no country level estimates. Several single hospital setting estimates exist for England and other countries, but the percentage of hospital-associated infections reported relies on identified cases in the absence of universal testing.Added value of this studyThis study provides the first national-level estimates of all symptomatic hospital-acquired infections with SARS-CoV-2 in England up to the 31st July 2020. Using comprehensive data, we calculate how many infections would be unidentified and hence can generate a total burden, impossible from just notification data. Moreover, our burden estimates for onward transmission suggest the contribution of hospitals to the overall infection burden.Implications of all the available evidenceLarge numbers of patients may become infected with SARS-CoV-2 in hospitals though only a small proportion of such infections are identified. Further work is needed to better understand how interventions can reduce such transmission and to better understand the contributions of hospital transmission to mortality.

The Impact of Clinical Factors on the Development of Late Radiation Toxicity: Results from the Medical Research Council RT01 Trial (ISRCTN47772397)

2011 ◽  
Vol 23 (9) ◽  
pp. 613-624 ◽  
Author(s):  
G.C. Barnett ◽  
G. De Meerleer ◽  
S.L. Gulliford ◽  
M.R. Sydes ◽  
R.M. Elliott ◽  
...  
Keyword(s):  
Medical Research ◽  
Research Council ◽  
Medical Research Council ◽  
Radiation Toxicity ◽  
Clinical Factors ◽  
The Impact

scholarly journals Systematic analysis of key parameters for genomics-based real-time detection and tracking of multidrug-resistant bacteria

2020 ◽  
Author(s):  
Claire L Gorrie ◽  
Anders Goncalves Da Silva ◽  
Danielle J Ingle ◽  
Charlie Higgs ◽  
Torsten Seemann ◽  
...  
Keyword(s):  
Medical Research ◽  
National Health ◽  
Research Council ◽  
Reference Genome ◽  
Medical Research Council ◽  
Sliding Window ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Variable Effect ◽  
The Impact

ABSTRACTBackgroundPairwise single nucleotide polymorphisms (SNPs) are a cornerstone for genomic approaches to multidrug-resistant organisms (MDROs) transmission inference in hospitals. However, the impact of key analysis parameters on these inferences has not been systematically analysed.MethodsWe conducted a multi-hospital 15-month prospective study, sequencing 1537 MDRO genomes for comparison; methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecium, and extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae. We systematically assessed the impact of sample and reference genome diversity, masking of prophage and regions of recombination, cumulative genome analysis compared to a three-month sliding-window, and the comparative effects each of these had when applying a SNP threshold for inferring likely transmission (≤15 SNPs for S. aureus, ≤25 for other species).FindingsAcross the species, using a reference genome of the same sequence type provided a greater degree of pairwise SNP resolution, compared to species and outgroup-reference alignments that typically resulted in inflated SNP distances and the possibility of missed transmission events. Omitting prophage regions had minimal impacts, however, omitting recombination regions a highly variable effect, often inflating the number of closely related pairs. Estimating pairwise SNP distances was more consistent using a sliding-window than a cumulative approach.InterpretationThe use of a closely-related reference genome, without masking of prophage or recombination regions, and a sliding-window for isolate inclusion is best for accurate and consistent MDRO transmission inference. The increased stability and resolution provided by these approaches means SNP thresholds for putative transmission inference can be more reliably applied among diverse MDROs.FundingThis work was supported by the Melbourne Genomics Health Alliance (funded by the State Government of Victoria, Department of Health and Human Services, and the ten member organizations); an National Health and Medical Research Council (Australia) Partnership grant (GNT1149991) and individual grants from National Health and Medical Research Council (Australia) to NLS (GNT1093468), JCK (GNT1008549) and BPH (GNT1105905).

scholarly journals The Medical Research Council Myeloma IX trial: the impact on treatment paradigms*

2011 ◽  
Vol 88 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Paul G. Richardson ◽  
Jacob P. Laubach ◽  
Robert L. Schlossman ◽  
Irene M. Ghobrial ◽  
Constantine S. Mitsiades ◽  
...  
Keyword(s):  
Medical Research ◽  
Research Council ◽  
Medical Research Council ◽  
Impact On Treatment ◽  
The Impact

Correlação entre a frequência respiratória e escalas de avaliação de dispneia

2016 ◽  
Vol 13 (6) ◽  
Author(s):  
Ivete Alonso Bredda Saad ◽  
Mariana De Moraes ◽  
Vinicius Minatel ◽  
Bruna Alonso Saad
Keyword(s):  
Medical Research ◽  
Research Council ◽  
Medical Research Council

A avaliação da dispneia tem sido feita por meio de instrumentos como escala de Borg modificada, a escala de cores e a escala do Medical Research Council modificada (mMRC). O objetivo deste estudo foi correlacionar a frequência respiratória com a sensação de dispneia, através das escalas citadas, correlacioná-las entre si e verificar se o grau de alfabetização influenciou na resposta do paciente sobre a sensação de dispneia. Para avaliar o esforço físico utilizou-se o teste de caminhada de seis minutos. Este foi um estudo prospectivo, transversal e analítico-descritivo composto por 124 voluntários com diagnóstico de doença pulmonar. Para comparar as variáveis categóricas entre os grupos foram utilizados os testes Qui-Quadrado e exato de Fisher. Para comparar as variáveis contínuas foi utilizado o teste Kruskal-Wallis e para análise de correlação foi utilizado o coeficiente de correlação de Spearman. A idade média foi de 55,9 (± 13,08 anos), 14% eram analfabetos. Nos tempos de análise houve correlação positiva entre as escalas mMRC e Borg, r = 0,43, r = 0,61 e r = 0,55. Entre as escalas mMRC e Cores, observou-se correlação negativa. Concluiu-se que a frequência respiratória correlacionou-se com as três escalas. O grau de alfabetização não modificou a resposta do paciente em relação à sensação de dispneia.Palavras-chave: dispneia, fisioterapia, avaliação.

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