An observational cohort study of bacterial co-infection and implications for empirical antibiotic therapy in patients presenting with COVID-19 to hospitals in North West London

Abstract Objectives To describe the prevalence and nature of bacterial co-infections in COVID-19 patients within 48 hours of hospital admission and assess the appropriateness of empirical antibiotic treatment they received. Methods In this retrospective observational cohort study, we included all adult non-pregnant patients who were admitted to two acute hospitals in North West London in March and April 2020 and confirmed to have COVID-19 infection within 2 days of admission. Results of microbiological specimens taken within 48 hours of admission were reviewed and their clinical significance was assessed. Empirical antibiotic treatment of representative patients was reviewed. Patient age, gender, co-morbidities, inflammatory markers at admission, admission to ICU and 30 day all-cause in-hospital mortality were collected and compared between patients with and without bacterial co-infections. Results Of the 1396 COVID-19 patients included, 37 patients (2.7%) had clinically important bacterial co-infection within 48 hours of admission. The majority of patients (36/37 in those with co-infection and 98/100 in selected patients without co-infection) received empirical antibiotic treatment. There was no significant difference in age, gender, pre-existing illnesses, ICU admission or 30 day all-cause mortality in those with and without bacterial co-infection. However, white cell count, neutrophil count and CRP on admission were significantly higher in patients with bacterial co-infections. Conclusions We found that bacterial co-infection was infrequent in hospitalized COVID-19 patients within 48 hours of admission. These results suggest that empirical antimicrobial treatment may not be necessary in all patients presenting with COVID-19 infection, although the decision could be guided by high inflammatory markers.

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Serum potassium disorders predict subsequent kidney injury: a retrospective observational cohort study of hospitalized patients

Kidney & Blood Pressure Research ◽

10.1159/000521833 ◽

2022 ◽

Author(s):

Gianmarco Lombardi ◽

Giovanni Gambaro ◽

Pietro Manuel Ferraro

Keyword(s):

Cohort Study ◽

Serum Potassium ◽

Hospital Admissions ◽

Kidney Injury ◽

Observational Cohort Study ◽

Hospitalized Patients ◽

P Value ◽

Significant Difference ◽

Observational Cohort ◽

Retrospective Observational Cohort Study

Introduction Electrolytes disorders are common findings in kidney diseases and might represent a useful biomarker preceding kidney injury. Serum potassium [K+] imbalance is still poorly investigated for association with acute kidney injury (AKI) and most evidence come from intensive care units (ICU). The aim of our study was to comprehensively investigate this association in a large, unselected cohort of hospitalized patients. Methods: We performed a retrospective observational cohort study on the inpatient population admitted to Fondazione Policlinico Universitario A. Gemelli IRCCS between January 1, 2010 and December 31, 2014 with inclusion of adult patients with at least 2 [K+] and 3 serum creatinine (sCr) measurements who did not develop AKI during an initial 10-day window. The outcome of interest was in-hospital AKI. The exposures of interest were [K+] fluctuations and hypo (HoK) and hyperkalemia (HerK). [K+] variability was evaluated using the coefficient of variation (CV). Cox proportional hazards regression models were used to obtain hazard ratios (HRs) and 95% confidence intervals (CIs) of the association between the exposures of interest and development of AKI. Results: 21,830 hospital admissions from 18,836 patients were included in our study. During a median follow-up of 5 (interquartile range [IQR] 7) days, AKI was observed in 555 hospital admissions (2.9%); median time for AKI development was 5 (IQR 7) days. Higher [K+] variability was independently associated with increased risk of AKI with a statistically significant linear trend across groups (p-value = 0.012). A significantly higher incidence of AKI was documented in patients with HerK compared with normokalemia. No statistically significant difference was observed between HoK and HerK (p-value = 0.92). Conclusion: [K+] abnormalities including fluctuations even within the normal range are associated with development of AKI.

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An Observational Cohort Study Evaluating Antimicrobial Use in Peripartum Sepsis: A Tendency towards Overdiagnosis?

Pharmacy ◽

10.3390/pharmacy8040211 ◽

2020 ◽

Vol 8 (4) ◽

pp. 211

Author(s):

Nouf Abutheraa ◽

June Grant ◽

Alexander B. Mullen

Keyword(s):

Cohort Study ◽

Group B Streptococcus ◽

Positive Culture ◽

Medication Administration ◽

Antimicrobial Treatment ◽

Observational Cohort Study ◽

Clinical Markers ◽

Clinical Specimens ◽

Sepsis Diagnosis ◽

Observational Cohort

(1) Background: Sepsis is the leading cause of maternal death in 11–15% of women worldwide. This emphasises the importance of administrating timely and appropriate antibiotic therapy to women with sepsis. We aimed to evaluate the appropriateness of antimicrobial prescribing in women diagnosed with peripartum sepsis. (2) Method: A prospective observational cohort study in a single Scottish health region with 12,233 annual live births. Data were collected on women diagnosed with sepsis in the peripartum period using physical and electronic medical records, drug Kardex® (medication administration) and ward handover records. (3) Results: A sepsis diagnosis was concluded in 89 of the 2690 pregnancy cases reviewed, with a median hospital stay of four days. Good overall adherence to the local guidelines for the empiric antimicrobial treatment of sepsis was observed. Group B Streptococcus was associated with 20.8% of maternal sepsis cases, whilst in 60% of clinical specimens tested no causative pathogen was isolated. (4) Conclusion: The lack of specific and sensitive clinical markers for sepsis, coupled with their inconsistent clinical application to inform diagnosis, hindered effective antimicrobial stewardship. This was further exacerbated by the lack of positive culture isolates from clinical specimens, which meant that patients were often continued on broader-spectrum empiric treatment.

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Observational cohort study of first-line bevacizumab combined with chemotherapy in metastatic colorectal cancer (HGCSG0802): Comparison of infusional FU/oxaliplatin(OX)+BV and oral FU/OX+BV.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.527 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 527-527 ◽

Cited By ~ 1

Author(s):

Kazuteru Hatanaka ◽

Satoshi Yuki ◽

Hiroshi Nakatsumi ◽

Hiraku Fukushima ◽

Hirohito Naruse ◽

...

Keyword(s):

Colorectal Cancer ◽

Cohort Study ◽

Adverse Events ◽

Metastatic Colorectal Cancer ◽

Observational Cohort Study ◽

Rank Test ◽

First Line ◽

Eligibility Criteria ◽

Significant Difference ◽

Observational Cohort

527 Background: A few reports have shown no difference between the efficacy of infusional FU and that of oral FU (Capecitabine/S-1) for colorectal cancer, and some studies have reported the non-inferiority between infusional FU/Oxaliplatin (OX) and oral FU/OX for metastatic colorectal cancer (mCRC). We performed a sub-group comparison between infusional FU/OX (mFOLFOX6 + BV: iFU) and oral FU/OX (CapeOX/SOX + BV: oFU) from the HGCSG0802 observational cohort study with investigated Japanese patients (pts) treated with first line BV for mCRC. Methods: The objective of HGCSG0802 was to evaluate progression-free survival (PFS), overall survival (OS), time to treatment-failure (TTF), response rate (RR), safety and so on. The key eligibility criteria of HGCSG0802 were with evaluable lesions, older than 20 years, ECOG PS 0-2, and this analysis used the cohort treated with OX-based regimens.In this analysis, pts characteristics, RR and safety were compared using Fisher’s exact test. PFS and TTF were compared using log-rank test. Results: Of 108 pts (the full analysis set), 95 pts were evaluable for treated with OX-based regimens. Forty-eight pts (50.5%) were treated with iFU and 47 pts (49.5%) were treated with oFU (CapeOX + BV 42 pts/SOX + BV 5 pts). The pts characteristics between those were generally balanced except for PS 0-1 (72.9% in iFU/93.6% in oFU; p=0.012) and synchronous liver metastases (mets) (93.8% in iFU/78.8% in oFU; p=0.040). Adverse events ≥grade 3 were balanced except for leucopenia (25.0% in iFU versus 2.1% in oFU; p=0.002) and neutropenia (43.5% in iFU and 10.9% in oFU; p=0.001). Hand-foot skin reaction was not different between two cohorts. RR was 62.5% in iFU versus 71.1% in oFU (p=0.835). The median PFS was 8.3 months in iFU versus 8.2 months in oFU (p=0.835). Conclusions: The HGCSG0802 could be a database to investigate first line BV for mCRC in clinical practice. As a result of this analysis, in Japanese daily practice, efficacy was no significant difference between infusional FU/OX and oral FU/OX, and the profiles of adverse events varied from each regimens.

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Faculty Opinions recommendation of Aggressive versus conservative initiation of antimicrobial treatment in critically ill surgical patients with suspected intensive-care-unit-acquired infection: a quasi-experimental, before and after observational cohort study.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717959395.793475300 ◽

2013 ◽

Author(s):

Mathias Pletz ◽

Philipp Reuken

Keyword(s):

Intensive Care Unit ◽

Cohort Study ◽

Intensive Care ◽

Antimicrobial Treatment ◽

Observational Cohort Study ◽

Surgical Patients ◽

Before And After ◽

Quasi Experimental ◽

Observational Cohort ◽

Critically Ill Surgical Patients

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Maternal Outcomes in Women with Major Degree Placenta Previa: An Observational Cohort Study

Current Women s Health Reviews ◽

10.2174/1573404817999201230234519 ◽

2020 ◽

Vol 17 ◽

Author(s):

Safinaz Reda Mahmoud Abdelwhab ◽

Ali El-Shabrawy Ali ◽

Mostafa Abdo Ahmed ◽

Basem Mohamed Hamed

Keyword(s):

Cohort Study ◽

Pregnant Women ◽

Placenta Previa ◽

Observational Cohort Study ◽

Maternal Outcomes ◽

Significant Difference ◽

Before And After ◽

Screening Protocol ◽

Observational Cohort ◽

Study Participants

Objective:: We aimed to evaluate the maternal outcomes among pregnant women with major degree placenta previa. Methods:: We conducted an observational cohort study on 80 pregnant women diagnosed with major placenta previa (grades III and IV where the placenta partially or completely cover the internal cervical os) after 20 weeks of pregnancy, within the period from January 2019 to June 2019. The diagnosis of placenta previa was made by ultrasound and confirmed at the time of delivery. The study participants were divided into three groups based on the placental location (Anterior, Central, and Posterior). All analyses were conducted using IBM SPSS software package version 20.0. Results:: Eighty pregnant women, with a mean age of 32.3 (5.01) years and a mean gestational age of 36.2 (2.03) weeks, were included in our study. Of them, 56.30% had a previous abortion, and previous Cs delivery was reported in 75%. Most of the placenta previa cases were central (52.5%), with a completely covered internal cervical os (70%). Thirty-nine patients (48.8%) had placenta accreta. Blood transfusion, postpartum hemorrhage, and anemia were noted with a percentage of 75%, 32.5%, and 32.5%, respectively. Around 28.8% of the included patients had a hysterectomy. Before and after delivery, nine patients (21.4%) and 15 patients (35.7%) of the placenta previa centralis group had anemia, respectively. Moreover, there was no statistically significant difference between the three studies groups in terms of anemia before and after delivery (P= 0.41 and P= 0.78. respectively). Placenta previa centralis showed a higher incidence of CS hysterectomy (45.2%) while wound infection was higher in anterior placenta previa (18.2%). Conclusion:: As a predictor of possible obstetric adverse events, placenta previa should be considered. A combination of proper clinical assessment and timely delivery to reduce the associated complications should be considered as well as developing a prenatal screening protocol.

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Observational cohort study of first-line bevacizumab combined with chemotherapy in metastatic colorectal cancer (HGCSG0802): Sub-group analysis by KRAS Exon2 status.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.3_suppl.782 ◽

2015 ◽

Vol 33 (3_suppl) ◽

pp. 782-782

Author(s):

Takenori Takahata ◽

Satoshi Yuki ◽

Hiroshi Nakatsumi ◽

Kazuaki Harada ◽

Hiraku Fukushima ◽

...

Keyword(s):

Colorectal Cancer ◽

Multivariate Analysis ◽

Cohort Study ◽

Adverse Events ◽

Group Analysis ◽

Observational Cohort Study ◽

First Line ◽

Mutational Status ◽

Significant Difference ◽

Observational Cohort

782 Background: A few reports have shown the efficacy of bevacizumab (BV) independent of the KRAS Exon2 mutational status (KRAS). We performed a sub-group analysis by KRAS from the HGCSG0802 observational cohort study with investigated 115 patients (pts) treated with first line BV for metastatic colorectal cancer (mCRC). Methods: The objective of HGCSG0802 was to evaluate progression-free survival (PFS), overall survival (OS), time to treatment-failure (TTF), response rate (RR), safety, etc. The key eligibility criteria were with evaluable lesions, older than 20 years, ECOG PS 0-2. In this analysis, pts characteristics, RR and safety were compared using Fisher’s exact test. Univariate and multivariate analysis for PFS were performed using patient characteristics. Survival analyses were performed with Kaplan-Meier method, log-rank test, and Cox proportional hazards model. Results: Of 108 pts (the full analysis set), 98 pts were evaluable for KRAS. Sixty-one pts (62.2%) had KRAS wild-type (wt) and 37 pts (37.8%) had mutation (mt). The pts characteristics between those with wt and with mt were generally balanced except for PS 0 (91.8% in wt, 75.7% in mt; p=0.037) and lung metastasis (34.4% in wt, 62.2% in mt; p=0.012).The median TTF was 7.4 months in wt versus 6.6 months in mt, and RR was 69.5% in wt versus 65.7% in mt. Adverse events related to BV were almost balanced except for bleeding (any grade) (31.1% in wt, 13.5% in mt; p=0.056).The median PFS was 9.9 months in wt versus 7.9 months in mt (HR=1.506; p=0.071). Although KRAS mt showed shorter PFS, there were not significant difference regardless of KRAS in Cox multivariate analysis (HR 1.314, 95% CI, 0.820-2.107, p=0.257). Conclusions: The HGCSG0802 could be a database to investigate first line BV for mCRC in clinical practice. Depending on the KRAS Exon2 mutational status, efficacy, and adverse events were no significant difference. We plan to conduct further follow up for survival, and to perform this analysis again.

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