Epidemiologic Investigation of a 2007 Outbreak of Serratia marcescens Bloodstream Infection in Texas Caused by Contamination of Syringes Prefilled With Heparin and Saline

2009 ◽  
Vol 30 (6) ◽  
pp. 593-595 ◽  
Author(s):  
John R. Su ◽  
David B. Blossom ◽  
Wendy Chung ◽  
Jessica Smartt Gullion ◽  
Neil Pascoe ◽  
...  
Keyword(s):  
Cohort Study ◽  
Serratia Marcescens ◽  
Bloodstream Infection ◽  
Retrospective Cohort Study ◽  
Outpatient Treatment ◽  
Retrospective Cohort ◽  
Epidemiologic Study ◽  
Epidemiologic Studies ◽  
Treatment Center ◽  
Epidemiologic Investigation

This retrospective cohort study found that syringes prefilled with heparin flush solution caused an outbreak of Serratia marcescens bloodstream infection at an outpatient treatment center in Texas in 2007. The epidemiologic study supported this conclusion, despite the lack of microbiologic evidence of contamination from environmental and product testing. This report underscores the crucial contributions that epidemiologic studies can make to investigations of outbreaks that are possibly product related.

scholarly journals Fosfomycin versus Ertapenem for Outpatient Treatment of Complicated Urinary Tract Infections: A Multicenter, Retrospective Cohort Study

2021 ◽  
Author(s):  
Noah Wald-Dickler ◽  
Todd C Lee ◽  
Soodtida Tangpraphaphorn ◽  
Susan M Butler-Wu ◽  
Nina Wang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Urinary Tract ◽  
Los Angeles ◽  
Urinary Tract Infections ◽  
Retrospective Cohort Study ◽  
Outpatient Treatment ◽  
Retrospective Cohort ◽  
Clinical Success ◽  
Public Hospitals ◽  
Tract Infections

Abstract Objectives We sought to determine the comparative efficacy of fosfomycin vs. ertapenem for outpatient treatment of complicated urinary tract infections (cUTI). Methods We conducted a multi-centered, retrospective cohort study involving patients with cUTI treated with outpatient oral fosfomycin vs. intravenous ertapenem at three public hospitals in Los Angeles County between January 2018 and September 2020. The primary outcome was resolution of clinical symptoms 30 days after diagnosis. Results We identified 322 patients with cUTI treated with fosfomycin (n = 110) or ertapenem (n = 212) meeting study criteria. Study arms had similar demographics, although patients treated with ertapenem more frequently had pyelonephritis or bacteremia while fosfomycin-treated patients had more retained catheters, nephrolithiasis, or urinary obstruction. Most infections were due to extended-spectrum β-lactamase-producing E. coli and Klebsiella pneumoniae; 80-90% of which were resistant to other oral options. Adjusted odds ratios for clinical success at 30 days, clinical success at last follow up, and relapse were 1.21 (0.68 to 2.16), 0.84 (0.46 to 1.52), and 0.94 (0.52 to 1.70), for fosfomycin vs. ertapenem, respectively. Patients treated with fosfomycin had significant reductions in length of hospital stay and length of antimicrobial therapy, and fewer adverse events (1 vs. 10). Fosfomycin outcomes were similar irrespective of duration of lead-in IV therapy or fosfomycin dosing interval (daily, every other day, every third day). Conclusion These results would support the conduct of a randomized controlled trial to verify efficacy. In the meantime, they suggest fosfomycin may be a reasonable stepdown from IV antibiotics for cUTI.

scholarly journals Duration of Antibiotic Therapy for Critically Ill Patients with Bloodstream Infections: A Retrospective Cohort Study

2013 ◽  
Vol 24 (3) ◽  
pp. 129-137 ◽  
Author(s):  
Thomas C Havey ◽  
Robert A Fowler ◽  
Ruxandra Pinto ◽  
Marion Elligsen ◽  
Nick Daneman
Keyword(s):  
Cohort Study ◽  
Bloodstream Infection ◽  
Critically Ill ◽  
Antibiotic Treatment ◽  
Retrospective Cohort Study ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Bloodstream Infections ◽  
Prolonged Treatment ◽  
Care Hospital

BACKGROUND: The optimal duration of antibiotic treatment for bloodstream infections is unknown and understudied.METHODS: A retrospective cohort study of critically ill patients with bloodstream infections diagnosed in a tertiary care hospital between March 1, 2010 and March 31, 2011 was undertaken. The impact of patient, pathogen and infectious syndrome characteristics on selection of shorter (≤10 days) or longer (>10 days) treatment duration, and on the number of antibiotic-free days, was examined. The time profile of clinical response was evaluated over the first 14 days of treatment. Relapse, secondary infection and mortality rates were compared between those receiving shorter or longer treatment.RESULTS: Among 100 critically ill patients with bloodstream infection, the median duration of antibiotic treatment was 11 days, but was highly variable (interquartile range 4.5 to 17 days). Predictors of longer treatment (fewer antibiotic-free days) included foci with established requirements for prolonged treatment, underlying respiratory tract focus, and infection withStaphylococcus aureusorPseudomonasspecies. Predictors of shorter treatment (more antibiotic-free days) included vascular catheter source and bacteremia with coagulase-negative staphylococci. Temperature improvements plateaued after the first week; white blood cell counts, multiple organ dysfunction scores and vasopressor dependence continued to decline into the second week. Among 72 patients who survived to 10 days, clinical outcomes were similar between those receiving shorter and longer treatment.CONCLUSION: Antibiotic treatment durations for patients with bloodstream infection are highly variable and often prolonged. A randomized trial is needed to determine the duration of treatment that will maximize cure while minimizing adverse consequences of antibiotics.

scholarly journals Time to recovery from COVID-19 and its predictors among patients admitted to treatment center of Wollega University Referral Hospital (WURH), Western Ethiopia: Survival analysis of retrospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252389
Author(s):  
Tadesse Tolossa ◽  
Bizuneh Wakuma ◽  
Dejene Seyoum Gebre ◽  
Emiru Merdassa Atomssa ◽  
Motuma Getachew ◽  
...  
Keyword(s):  
Cohort Study ◽  
Regression Model ◽  
Median Time ◽  
Retrospective Cohort Study ◽  
Recovery Time ◽  
Retrospective Cohort ◽  
Cox Regression ◽  
Older Age ◽  
Treatment Center ◽  
P Value

Introduction Despite its alarming spread throughout the world, no effective drug and vaccine is discovered for COVID-19 so far. According to WHO, the recovery time from COVID-19 was estimated to be 2 weeks for patients with mild infection, and 3 to 6 weeks for those with serious illnesses. A studies regarding the median recovery time and its predictors are limited globally and specifically in Ethiopia. Therefore, the aim of this study was to estimate the median time to recovery from COVID-19 and its predictors among COVID-19 cases admitted to WURH, Western Ethiopian. Methods This was a hospital-based retrospective cohort study conducted among 263 adult patients admitted with COVID-19 in WURH treatment center from March 29, 2020 through September 30, 2020. Epidata version 3.2 was used for data entry, and STATA version 14 for analysis. A Cox proportional hazard regression model was fitted to determine factors associated with recovery time. A variable with P-value ≤ 0.25 at bivariable Cox regression analysis were selected for multivariable Cox proportional model. Multivariable Cox regression model with 95% CI and Adjusted Hazard Ratio (AHR) was used to identify a significant predictor of time to recovery from COVID-19 at P-value < 0.05. Results The mean age of patient was 36.8 (SD± 10.68) years. At the end of follow up, two hundred twenty seven observations were developed an event (recovered) with median time to recovery of 18 days with IQR of 10–27 days. The overall incidence rate of recovery was of 4.38 per 100 (95% CI: 3.84, 4.99) person-days observations. Being older age (AHR = 1.59, 95% CI: 1.02, 2.49), presence of fever on admission (AHR = 1.78, 95% CI: 1.21, 2.62), and comorbidity (AHR = 0.56, 95% CI, 0.34, 0.90) were found to have statistically significant association with recovery time. Conclusion and recommendations In general, the median recovery time of patients with COVID-19 cases was long, and factors such as older age group, presence of fever, and comorbidity was an independent predictors of delayed recovery from COVID-19. Intervention to further reduce recovery time at treatment center has to focus on patients those shows symptoms and with comorbidities.

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