scholarly journals Assessing the appropriateness of antimicrobial therapy in patients with sepsis at a Vietnamese national hospital

2021 ◽  
Vol 3 (2) ◽  
Author(s):  
Nam Nguyen-Hoang ◽  
Quynh Thi Huong Bui
Keyword(s):  
Septic Shock ◽  
Treatment Outcomes ◽  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Bayesian Model Averaging ◽  
Patient Treatment ◽  
National Hospital ◽  
Related Factors ◽  
Factors Associated ◽  
Empirical Antimicrobial Therapy

Abstract Objectives To assess the appropriateness of empirical antimicrobial therapy for sepsis and septic shock and determine factors associated with patient treatment outcomes at a Vietnamese national hospital. Methods A cross-sectional study was conducted on 134 patients diagnosed with sepsis and/or septic shock at Thong-Nhat Hospital, Ho Chi Minh City, Vietnam, from January 2018 to June 2018. Appropriateness of antimicrobial therapy was defined as physician adherence to antimicrobial guidelines using the Sanford Guide to Antimicrobial Therapy and the Vietnam national guidelines. Bayesian model averaging technique was used to identify the related factors associated with patient treatment outcomes. Results The median age of patients was 70 years. Organisms were identified in 54.5% of cases and predominated by Escherichia coli and staphylococci. Appropriate empirical antimicrobial agents were initiated in 56.6% (n = 73) of all cases. Of these patients, 31 cases (42.5%) and 61 cases (83.6%) received the antimicrobials in accordance with recommendations related to dosage and route of administration, respectively, bringing the overall rate of appropriate empirical antimicrobial therapy down to 23.3%. Patients who progressed to septic shock, received inappropriate antimicrobial therapy and required ICU admission were more likely to suffer treatment failure. Conclusions The study findings suggest that clinicians should appropriately adhere to antimicrobial guidelines, especially in patients with septic shock and those who require ICU care, to improve treatment outcomes.

scholarly journals Clinical and Demographic Factors Associated with Antipyretic Use in Gram-Negative Severe Sepsis and Septic Shock

2011 ◽  
Vol 45 (10) ◽  
pp. 1207-1216 ◽  
Author(s):  
Nicholas M Mohr ◽  
Brian M Fuller ◽  
Lee P Skrupky ◽  
Hawnwan Moy ◽  
Robert Alunday ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Medical Center ◽  
Academic Medical Center ◽  
Demographic Factors ◽  
Medication Administration ◽  
Patient Treatment ◽  
Gram Negative ◽  
Factors Associated ◽  
Sepsis And Septic Shock

Background: Antipyretic therapy is commonly prescribed for patients with Infection, but studies of its impact on clinical outcomes have yielded mixed results. No data exist to characterize the use of antipyretic medications in patients with severe sepsis or septic shock. Objective: To identify clinical and demographic factors associated with antipyretic medication administration in severe sepsis and septic shock. Methods: This single-center, retrospective, cohort study assessed febrile patients [temperature ≥38.3°C) with gram-negative severe sepsis or septic shock at an 1111-bed academic medical center between January 2002 and February 2008, Patients were excluded if they had liver disease, acute brain injury, or allergy to acetaminophen. Generalized estimating equations were used to estimate the effect of clinical factors on treatment of patients with antipyretic medications, Results: Although 76% of patients in this febrile cohort (n = 241) were prescribed an antipyretic agent, only 42% received antipyretic therapy; 95% of the doses were acetaminophen. Variables associated with antipyretic treatment were maximum body temperature (OR 2.11, 95% CI 1.53 to 2.89), time after sepsis diagnosis (OR 0.88, 95% CI 0.82 to 0.95), surgery during hospitalization (OR 0.49, 95% CI 0.31 to 0.80), death within 36 hours (OR 0.35, 95% CI 0.15 to 0.85). and mechanical ventilation (OR 0.58, 95% CI 0.34 to 0.98). Severity of illness factors, demographic factors, and patient treatment location did not predict who would receive antipyretic therapy. Conclusions: Most febrile episodes in patients with gram-negative severe sepsis or septic shock were not treated with antipyretic medications. Further studies are needed to demonstrate the effect of antipyretics on clinically relevant outcomes in severe sepsis and septic shock.

Patient and Organizational Factors Associated With Delays in Antimicrobial Therapy for Septic Shock*

2016 ◽  
Vol 44 (12) ◽  
pp. 2145-2153 ◽  
Author(s):  
Andre C. K. B. Amaral ◽  
Robert A. Fowler ◽  
Ruxandra Pinto ◽  
Gordon D. Rubenfeld ◽  
Paul Ellis ◽  
...  
Keyword(s):  
Septic Shock ◽  
Antimicrobial Therapy ◽  
Organizational Factors ◽  
Factors Associated

Empirical antimicrobial therapy of septic shock patients: Adequacy and impact on the outcome*

2003 ◽  
Vol 31 (2) ◽  
pp. 462-467 ◽  
Author(s):  
Marc Leone ◽  
Aurélie Bourgoin ◽  
Sylvie Cambon ◽  
Myriam Dubuc ◽  
Jacques Albanèse ◽  
...  
Keyword(s):  
Septic Shock ◽  
Antimicrobial Therapy ◽  
Empirical Antimicrobial Therapy

Prevalence of safer needle devices and factors associated with their adoption: results of a national hospital survey

2002 ◽  
Vol 117 (4) ◽  
pp. 340-349 ◽  
Author(s):  
Raymond C Sinclair ◽  
Andrew Maxfield ◽  
Ellen L Marks ◽  
Douglas R Thompson ◽  
Robyn R.M Gershon
Keyword(s):  
National Hospital ◽  
Factors Associated

Management of Recurrent or Progressing Skull Base Chondrosarcomas: Predictors of Long-Term Outcomes

2020 ◽  
Author(s):  
Jonathan D. Breshears ◽  
Franco DeMonte ◽  
Ahmed Habib ◽  
Paul W. Gidley ◽  
Shaan M. Raza
Keyword(s):  
Natural History ◽  
Skull Base ◽  
Radiation Treatment ◽  
Systemic Disease ◽  
Primary Treatment ◽  
Salvage Treatment ◽  
Low Grade ◽  
Related Factors ◽  
Factors Associated ◽  
Initial Recurrence

Abstract Background Skull base chondrosarcomas (CSA) are difficult tumors to cure and there is little data regarding salvage therapy. Objective This study aims to identify presentation and treatment-related factors which impact the progression free survival (PFS) and disease specific survival (DSS) for recurrent CSA, and to identify salvage treatment factors associated with successful restoration to the natural history following primary treatment. Methods This single-institution retrospective review included patients with recurrent/progressive CSA over a 25-year period. Survival analysis for factors impacting PFS and DSS was performed. Salvage treatment factors associated with achieving PFS ≥newly diagnosed median PFS were identified using univariate statistics. Analysis was performed on first recurrences and all recurrences combined. Results A total of 47 recurrence/progression events were analyzed from 17 patients (median two events/patient, range = 1–8). The overall PFS and DSS for the initial recurrence was 32 (range = 3–267) and 79 (range = 3–285) months, respectively. Conventional grade III or mesenchymal histology significantly predicted shorter PFS and DSS (p < 0.0001). After stratification by histology, previous radiation predicted shorter PFS for low-grade tumors (p = 0.009). Gross total resection (GTR) after a first time recurrence was significantly associated with successful salvage treatment (p < 0.05); however, this was rare. Conclusion In this series, high grade histology and prior radiation treatment negatively impacted salvage treatment outcomes, while GTR was associated with restoration to natural history following primary treatment. Careful consideration of histology, systemic disease status, previous treatments, and the anatomic extent of the skull base disease can optimize the outcomes of salvage intervention.

scholarly journals Effect of COPD on the Hospital Outcomes and Mortality among Hemorrhagic Stroke Patients. Sex Differences in a Population-Based Study

2021 ◽  
Vol 10 (11) ◽  
pp. 2491
Author(s):  
Javier de Miguel-Diez ◽  
Marta Lopez-Herranz ◽  
Rodrigo Jiménez-García ◽  
Valentín Hernández-Barrera ◽  
Isabel Jimenez-Trujillo ◽  
...  
Keyword(s):  
Sex Differences ◽  
Decompressive Craniectomy ◽  
Hemorrhagic Stroke ◽  
Population Based ◽  
Stroke Patients ◽  
National Hospital ◽  
Population Based Study ◽  
Factors Associated ◽  
Adjusted Incidence ◽  
Discharge Database

(1) Background: It is not well known whether there is an association between COPD and hemorrhagic stroke (HS). We aim to analyze the incidence, clinical characteristics, procedures, and outcomes of HS in patients with and without COPD and to assess sex differences. Secondly, to identify factors associated with in-hospital mortality (IHM). (2) Methods: Patients aged ≥40 years hospitalized with HS included in the Spanish National Hospital Discharge Database (2016–2018) were analyzed. Propensity score matching (PSM) was used to compare patients according to sex and COPD status. (3) Results: We included 55,615 patients (44.29% women). Among men with COPD the HS adjusted incidence was higher (IRR 1.31; 95% CI 1.24–1.57) than among non-COPD men. COPD men had higher adjusted incidence of HS than COPD women (IRR 1.87; 95% CI 1.85–1.89). After matching, COPD men had a higher IHM (29.96% vs. 27.46%; p = 0.032) than non-COPD men. Decompressive craniectomy was more frequently conducted among COPD men than COPD women (6.74% vs. 4.54%; p = 0.014). IHM increased with age and atrial fibrillation, while decompressive craniectomy reduced IHM. (4) Conclusions: COPD men had higher incidence and IHM of HS than men without COPD. COPD men had higher incidence of HS than COPD women. Decompressive craniectomy was more frequently conducted in COPD men than COPD women and this procedure was associated to better survival.

scholarly journals Bacterial pneumonia coinfection and antimicrobial therapy duration in SARS-CoV-2 (COVID-19) infection

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Liam Townsend ◽  
Gerry Hughes ◽  
Colm Kerr ◽  
Mary Kelly ◽  
Roisin O’Connor ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Antimicrobial Treatment ◽  
Respiratory Pathogens ◽  
Factors Associated ◽  
Reactive Protein ◽  
Prolonged Duration ◽  
Bacterial Coinfection ◽  
Tract Infections ◽  
Culture Positivity Rate

Abstract Background Bacterial respiratory coinfection in the setting of SARS-CoV-2 infection remains poorly described. A description of coinfection and antimicrobial usage is needed to guide ongoing antimicrobial stewardship. Objectives To assess the rate of empirical antimicrobial treatment in COVID-19 cases, assess the rate and methods of microbiological sampling, assess the rate of bacterial respiratory coinfections and evaluate the factors associated with antimicrobial therapy in this cohort. Methods Inpatients with positive SARS-CoV-2 PCR were recruited. Antibiotic prescription, choice and duration were recorded. Taking of microbiological samples (sputum culture, blood culture, urinary antigens) and culture positivity rate was also recorded. Linear regression was performed to determine factors associated with prolonged antimicrobial administration. Results A total of 117 patients were recruited; 84 (72%) were prescribed antimicrobial therapy for lower respiratory tract infections. Respiratory pathogens were identified in seven (6%) patients. The median duration of antimicrobial therapy was 7 days. C-reactive protein level, oxygen requirement and positive cultures were associated with prolonged duration of therapy. Conclusions The rate of bacterial coinfection in SARS-CoV-2 is low. Despite this, prolonged courses of antimicrobial therapy were prescribed in our cohort. We recommend active antimicrobial stewardship in COVID-19 cases to ensure appropriate antimicrobial prescribing.

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