De-escalation of Empiric Antibiotics Following Negative Cultures in Hospitalized Patients With Pneumonia: Rates and Outcomes

2020 ◽  
Author(s):  
Abhishek Deshpande ◽  
Sandra S Richter ◽  
Sarah Haessler ◽  
Peter K Lindenauer ◽  
Pei-Chun Yu ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Empiric Therapy ◽  
Multidrug Resistant ◽  
Hospitalized Patients ◽  
Transfer Length ◽  
Multidrug Resistant Organisms ◽  
Patients At Risk ◽  
Icu Transfer

Abstract Background For patients at risk for multidrug-resistant organisms, IDSA/ATS guidelines recommend empiric therapy against methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas. Following negative cultures, the guidelines recommend antimicrobial de-escalation. We assessed antibiotic de-escalation practices across hospitals and their associations with outcomes in hospitalized patients with pneumonia with negative cultures. Methods We included adults admitted with pneumonia in 2010–2015 to 164 US hospitals if they had negative blood and/or respiratory cultures and received both anti-MRSA and antipseudomonal agents other than quinolones. De-escalation was defined as stopping both empiric drugs on day 4 while continuing another antibiotic. Patients were propensity adjusted for de-escalation and compared on in-hospital 14-day mortality, late deterioration (ICU transfer), length-of-stay (LOS), and costs. We also compared adjusted outcomes across hospital de-escalation rate quartiles. Results Of 14 170 patients, 1924 (13%) had both initial empiric drugs stopped by hospital day 4. Hospital de-escalation rates ranged from 2–35% and hospital de-escalation rate quartile was not significantly associated with outcomes. At hospitals in the top quartile of de-escalation, even among patients at lowest risk for mortality, the de-escalation rates were <50%. In propensity-adjusted analysis, patients with de-escalation had lower odds of subsequent transfer to ICU (adjusted odds ratio, .38; 95% CI, .18–.79), LOS (adjusted ratio of means, .76; .75–.78), and costs (.74; .72–.76). Conclusions A minority of eligible patients with pneumonia had antibiotics de-escalated by hospital day 4 following negative cultures and de-escalation rates varied widely between hospitals. To adhere to recent guidelines will require substantial changes in practice.

scholarly journals Invasive Candidiasis in Hospitalized Patients with Major Burns

2022 ◽  
Vol 12 (1) ◽  
pp. 47
Author(s):  
Yi-Ling Lin ◽  
I-Chen Chen ◽  
Jung-Hsing Yen ◽  
Chih-Sheng Lai ◽  
Yueh-Chi Tsai ◽  
...  
Keyword(s):  
Risk Factors ◽  
Invasive Candidiasis ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Total Body Surface Area ◽  
Reference Value ◽  
Hospitalized Patients ◽  
Research Database ◽  
Specific Population ◽  
Total Body

Background: Invasive candidiasis (IC) is a major cause of morbidities and mortality in patients hospitalized with major burns. This study investigated the incidence of IC in this specific population and analyzed the possible risk factors. Materials and Methods: We retrospectively analyzed data from the National Health Insurance Research Database (NHIRD) of Taiwan. We identified 3582 patients hospitalized with major burns on over 20% of their total body surface area (TBSA) during 2000–2013; we further analyzed possible risk factors. Result: IC was diagnosed in 452 hospitalized patients (12.6%) with major burns. In the multivariate analysis, patients older than 50 years (adjusted odds ratio (OR) = 1.96, 95% confidence interval (CI) 1.36–2.82), those of female sex (adjusted OR = 1.33, 95% CI 1.03–1.72), those with burns on the head (adjusted OR = 1.33, 95% CI 1.02–1.73), and those with burns over a greater TBSA had higher risks of IC. Conclusion: Treating IC is crucial in healthcare for major burns. Our study suggests that several risk factors are associated with IC in patients hospitalized with major burns, providing reliable reference value for clinical decisions.

scholarly journals Outcomes of Hospitalized Patients with Glucocorticoid-Induced Hyperglycemia—A Retrospective Analysis

2020 ◽  
Vol 9 (12) ◽  
pp. 4079
Author(s):  
Neele Delfs ◽  
Tristan Struja ◽  
Sandra Gafner ◽  
Thaddaeus Muri ◽  
Ciril Baechli ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Cardiovascular Events ◽  
Adjusted Odds Ratio ◽  
Adverse Outcome ◽  
Hospitalized Patients ◽  
Secondary Outcome ◽  
Treat To Target ◽  
Inclusion Criteria ◽  
Future Studies ◽  
Target Treatment

Background: Glucocorticoid (GC)-induced hyperglycemia is a frequent side effect in hospitalized patients. Guidelines recommend treat-to-target treatment between 6–10 mmol/L (108–180 mg/dL) with insulin, but data on outcome is scarce. We investigated the 30-day outcome in hospitalized patients receiving GCs. Methods: All patient records of hospitalized patients between January 2014 and April 2018 were screened for GC administration and consecutive hyperglycemia. The primary combined endpoint consisted of death, cardiovascular events, and infections until 30 days after admission. Hypoglycemia was a secondary outcome. Results: Of the 2424 hospitalized patients (9.6% of all hospitalized patients) who received systemic GCs and met inclusion criteria, the overall incidence for GC-induced hyperglycemia was 812 (33.5%), and 89 (3.7%) had at least one documented hypoglycemia during their hospital stay. Compared to patients with normoglycemia, GC-induced hyperglycemia had an adjusted-odds ratio of 1.68 (95% CI 1.25–2.26) for the combined primary endpoint. Hypoglycemia even had an odds ratio of 1.95 (95% CI 1.2–3.17). Conclusions: Mortality, cardiovascular events, and rate of infections were markedly higher in patients with GC-induced hyperglycemia as compared to patients with normoglycemia. Importantly, hypoglycemia was associated with a doubled risk for adverse outcome. Future studies should evaluate whether optimized glucose control by minimizing the risk for hypoglycemia has a beneficial effect on clinical outcomes in patients with GC-induced hyperglycemia.

Prevalence of multidrug-resistant organisms on palliative care patients in a university hospital–bound palliative care unit: A prospective cohort analysis

2020 ◽  
Vol 34 (6) ◽  
pp. 776-783 ◽  
Author(s):  
Tobias Georg Strapatsas ◽  
Viola Simons ◽  
Beniam Ghebremedhin ◽  
Parviz Ahmad-Nejad ◽  
Oliver Schmalz
Keyword(s):  
Staphylococcus Aureus ◽  
Palliative Care ◽  
Confidence Interval ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Cohort Analysis ◽  
Multidrug Resistant ◽  
Interquartile Range ◽  
University Hospital ◽  
Methicillin Resistant ◽  
Multidrug Resistant Organisms

Background: Multidrug-resistant organisms are a growing challenge and burden to patient care. To date, there are only data concerning the prevalence of methicillin-resistant Staphylococcus aureus infections. Thus, numbers of other multidrug-resistant organisms can only be extrapolated and inferred from more or less comparable cohorts. Aim: To evaluate the prevalence of multidrug-resistant organisms on palliative care in-patients. Design: A prospective cohort analysis Setting/participants: A University Hospital–bound palliative care unit, in which all patients admitted to the unit were screened for inclusion. Results: In total, 304 patients were included in this study. The prevalence for methicillin-resistant Staphylococcus aureus of 5.2% (95% confidence interval: 2.9%–8.4%), for vancomycin-resistant Enterococcus faecium of 10.5% (95% confidence interval: 7.2%–14.8%), for Ciprofloxacin-resistant-extended spectrum beta-lactamases isolates of 5.8% (95% confidence interval: 3.4%–9.3%) and Ciprofloxacin-resistant Carbapenem-resistant Gram-negative bacteria of 0.3% (95% confidence interval: 0%–1.3%) was calculated. Except for methicillin-resistant Staphylococcus aureus, patients carrying a multidrug-resistant organism had a significant longer duration of hospitalization. Median length of stay was 12 days (interquartile range: 14.5, no multidrug-resistant organisms), 14.5 days (interquartile range: 15, methicillin-resistant Staphylococcus aureus), 21 days (interquartile range: 16.5, vancomycin-resistant enterococci), 22 days (interquartile range: 20.75, Ciprofloxacin-resistant-extended spectrum beta-lactamases) and 32 days (interquartile range: 22.00) for patients carrying two organisms. Conclusion: There is a high prevalence of all multidrug-resistant organisms within the hospitalized palliative care patients. However, the multidrug-resistant organisms do not seem to impact the survival within this cohort. Further studies should evaluate additional end-points, for example, quality of life, which are of special interest in this cohort.

scholarly journals Prolonged Colonization with the Methicillin-Resistant Staphylococcus aureus Strain USA300 among Residents of Extended Care Facilities

2010 ◽  
Vol 31 (8) ◽  
pp. 838-841 ◽  
Author(s):  
Simone M. Shurland ◽  
O. Colin Stine ◽  
Richard A. Venezia ◽  
Jennifer K. Johnson ◽  
Min Zhan ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Odds Ratio ◽  
Retrospective Cohort ◽  
Adjusted Odds Ratio ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Aureus Strain ◽  
Methicillin Resistant ◽  
Extended Care ◽  
Care Facilities ◽  
Mrsa Strains

We performed a retrospective cohort study (n = 129) to assess whether residents of extended care facilities who were initially colonized or infected with the methicillin-resistant Staphylococcus aureus (MRSA) strain USA300 were less likely to have prolonged colonization than were residents colonized or infected with other MRSA strains. We found no difference in prolonged colonization (adjusted odds ratio, 1.1 [95% confidence interval, 0.5–2.4]).

scholarly journals Association of subclinical hypercortisolism with type 2 diabetes mellitus: a case-control study in hospitalized patients

2005 ◽  
Vol 153 (6) ◽  
pp. 837-844 ◽  
Author(s):  
Iacopo Chiodini ◽  
Massimo Torlontano ◽  
Alfredo Scillitani ◽  
Maura Arosio ◽  
Simonetta Bacci ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Plasma Cortisol ◽  
Adjusted Odds Ratio ◽  
Hospitalized Patients ◽  
Diabetic Patients ◽  
Subclinical Hypercortisolism ◽  
Free Cortisol

Objective: Subclinical hypercortisolism (SH) may play a role in several metabolic disorders, including diabetes. No data are available on the relative prevalence of SH in type 2 diabetes (T2D). In order to compare the prevalence of SH in T2D and matched non-diabetic control individuals, we performed a case-controlled, multicenter, 12-month study, enrolling 294 consecutive T2D inpatients (1.7% dropped out the study) with no evidence of clinical hypercortisolism and 189 consecutive age- and body mass index-matched non-diabetic inpatients (none of whom dropped out). Design and methods: Ascertained SH (ASH) was diagnosed in individuals (i) with plasma cortisol after 1 mg overnight dexamethasone suppression >1.8 μg/dl (50 nmol/l), (ii) with more than one of the following: (a) urinary free cortisol >60.0 μg/24 h (165.6 nmol/24 h), (b) plasma ACTH <10.0 pg/ml (2.2 pmol/l) or (c) plasma cortisol >7.5 μg/dl (207 nmol/l) at 24:00 h or >1.4 μg/dl (38.6 nmol/l) after dexamethasone-CRH (serum cortisol after corticotrophin-releasing hormone stimulus during dexamethasone administration) test, and (iii) in whom the source of glucocorticoid excess was suggested by imaging and by additional biochemical tests (for ACTH-dependent ASH). Results: Prevalence of ASH was higher in diabetic individuals than in controls (9.4 versus 2.1%; adjusted odds ratio, 4.8; 95% confidence interval, 1.6–14.1; P = 0.004). In our population the proportion of T2D which is statistically attributable to ASH was approx. 7%. Among diabetic patients, the presence of severe diabetes (as defined by the coexistence of hypertension, dyslipidaemia and insulin treatment) was significantly associated with SH (adjusted odds ratio, 3.8; 95% confidence interval, 1.4–10.2; P = 0.017). Conclusions: In hospitalized patients, SH is associated with T2D.

scholarly journals Predictors of hospital mortality among patients with COVID-19 in Tehran, Iran

2021 ◽  
Vol 9 ◽  
pp. 205031212110515
Author(s):  
Fatemeh Esfahanian ◽  
SeyedAhmad SeyedAlinaghi ◽  
Nazanin Janfaza ◽  
Marcarious M. Tantuoyir
Keyword(s):  
Logistic Regression ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Laboratory Data ◽  
Hospitalized Patients ◽  
Multivariate Logistic Regression ◽  
Predictors Of Mortality ◽  
Laboratory Test Results ◽  
History Of

Objective: The coronavirus disease 2019 (COVID-19) has become a global pandemic. Timely and effective predictors of survival and death rates are crucial for improving the management of COVID-19 patients. In this study, we evaluated the predictors of mortality based on the demographics, comorbidities, clinical characteristics, laboratory findings, and vital signs of 500 patients with COVID-19 admitted at Imam Khomeini Hospital Complex, the biggest hospital in Tehran, Iran. Methods: Five hundred hospitalized laboratory-confirmed COVID-19 patients were included in this study. Subsequently, electronic medical records, including patient demographics, clinical manifestation, comorbidities, and laboratory test results were collected and analyzed. They were divided into two groups: expired and discharged. Demographics, clinical, and laboratory data were compared among the two groups. The related factors with death in the patients were determined using univariate and multivariate logistic regression approaches. Results: Among the 500 hospitalized patients, most patients were male (66.4% versus 33.6%). The expired group had more patients ⩾70 years of age compared with the discharged group (32.9% versus 16.3%, respectively). Almost 66% of the expired patients were hospitalized for ⩾5 days which was higher than the discharge group (26.9%). Patients with a history of opium use in the expired group were significantly higher compared to the discharged group (14.8% versus 8.6%, p = 0.04) as well as a history of cancer (15.5% versus 4.7%, p < 0.001). Out of the 500 patients with COVID-19, four patients (2.6%) were HIV positive, all of whom expired. Dyspnea (76.4%), fever (56.6%), myalgia (59.9%), and dry cough (67%) were the most common chief complaints of hospitalized patients. Age ⩾70 years (adjusted odds ratio = 2.49; 95% confidence interval, 1.02–6.04), being female (adjusted odds ratio = 2.06; 95% confidence interval, 1.25–3.41), days of hospitalization (adjusted odds ratio = 5.73; 95% confidence interval, 3.49–9.41), and having cancer (adjusted odds ratio = 3.23; 95% confidence interval, 1.42–7.39) were identified as independent predictors of mortality among COVID-19 patients. Conclusion: Discharged and expired COVID-19 patients had distinct clinical and laboratory characteristics, which were separated by principal component analysis. The mortality risk factors for severe patients identified in this study using a multivariate logistic regression model included elderly age (⩾70 years), being female, days of hospitalization, and having cancer.

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