scholarly journals Predictors of readmission following discharge of patients with Gram-negative bacteremia: a retrospective cohort study

2021 ◽  
Author(s):  
Yanay Porat ◽  
Jeries Nashashibi ◽  
Itamar Poran ◽  
Mical Paul
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Prediction Models ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Operating Characteristics ◽  
Gram Negative ◽  
Gram Negative Bacteremia ◽  
Cephalosporin Resistance

Abstract Background Short-term readmission is an important outcome reflecting the poor trajectory of sepsis survivors. The aim of this study was to identify the major risk factors for 30 day-readmission among patients with Gram-negative bacteremia. Methods Retrospective cohort study including all consecutive adults hospitalized in the medical departments in a referral hospital in Israel with Gram-negative bacteremia between 2011 to 2020, who were discharged alive. Predictors for 30-day readmission were investigated, considering death after discharge as a competing event. Cephalosporin resistance was our predictor of interest. Sub-distribution hazard ratios (HR) of the cumulative incidence function were investigated using the Fine and Gray multivariable competing-risk regression model. The prediction models were cross-validated using the k-fold method. Results Among 2,196 patients surviving hospitalization with Gram-negative bacteremia, the mean age was 70±16 years and 432 (19.6%) were readmitted within 30 days. Variables associated readmission hazards included were Arab ethnicity, active malignancy, conditions requiring immune-suppression, anxiolytics or hypnotics, anticoagulant or antiplatelet therapy, discharge with a nasogastric tube, higher pre-discharge heart rate, duration of antibiotic therapy during hospitalization and bacteremia caused by cephalosporin-resistant bacteria (HR 1.23, 95% CI 0.99-1.52). The area under the receiver-operating characteristics curve for this model was 75.5% (95% CI 71.3-79.1%). In secondary models, cephalosporin resistance and inappropriate empirical antibiotic treatment and lower pre-discharge albumin, were significantly associated with re-admission. Conclusion 30-day re-admissions among patients with Gram-negative bacteremia surviving the index admission are high. Readmission was related to comorbidities and infections caused by multidrug-resistant infections.

Colistin therapy for microbiologically documented multidrug-resistant Gram-negative bacterial infections: a retrospective cohort study of 258 patients

2010 ◽  
Vol 35 (2) ◽  
pp. 194-199 ◽  
Author(s):  
Matthew E. Falagas ◽  
Petros I. Rafailidis ◽  
Elda Ioannidou ◽  
Vangelis G. Alexiou ◽  
Dimitrios K. Matthaiou ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Bacterial Infections ◽  
Multidrug Resistant ◽  
Gram Negative

scholarly journals Association between tocilizumab and emerging multidrug-resistant organisms in critically ill patients with COVID-19: A multicenter, retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ohoud Aljuhani ◽  
Khalid Al Sulaiman ◽  
Adel Alshabasy ◽  
Khalid Eljaaly ◽  
Abdulrahman I. Al Shaya ◽  
...  
Keyword(s):  
Cohort Study ◽  
Critically Ill ◽  
Retrospective Cohort Study ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Randomized Clinical Trials ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Control Group ◽  
Microbial Isolation

Abstract Background Tocilizumab is an IgG1 class recombinant humanized monoclonal antibody that directly inhibits the IL-6 receptor. Several randomized clinical trials have evaluated its safety and efficacy in patients with coronavirus disease 2019 (COVID-19), and these studies demonstrate conflicting results. Our study aimed to determine the association between tocilizumab treatment and microbial isolation and emergence of multidrug-resistant bacteria in critically ill patients with COVID-19. Methods A multicenter retrospective cohort study was conducted at two tertiary government hospitals in Saudi Arabia. All critically ill patients admitted to intensive care units with a positive COVID-19 PCR test between March 1 and December 31, 2020, who met study criteria were included. Patients who received tocilizumab were compared to those who did not receive it. Results A total of 738 patients who met our inclusion criteria were included in the analysis. Of these, 262 (35.5%) received tocilizumab, and 476 (64.5%) were included in the control group. Patients who received tocilizumab had higher odds for microbial isolation (OR 1.34; 95% CI 0.91–1.94, p = 0.13); however, the difference was not statistically significant. Development of resistant organisms (OR 1.00; 95% CI 0.51–1.98, p = 0.99) or detection of carbapenem-resistant Enterobacteriaceae (CRE) (OR 0.67; 95% CI 0.29–1.54, p = 0.34) was not statistically significant between the two groups. Conclusions Tocilizumab use in critically ill patients with COVID-19 is not associated with higher microbial isolation, the emergence of resistant organisms, or the detection of CRE organisms.

scholarly journals Secondary erythrocytosis following drugs used in rifampicin/multidrug-resistant tuberculosis: a retrospective cohort study

2021 ◽  
Vol 8 (1) ◽  
pp. e001064
Author(s):  
Sirak Tesfamariam ◽  
Amon Solomon Ghebrenegus ◽  
Henok Woldu ◽  
Ephrem Fisseha ◽  
Gebremeskel Belai ◽  
...  
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Statistical Significance ◽  
Multidrug Resistant ◽  
Hospital Data ◽  
Resistant Tuberculosis ◽  
Multidrug Resistant Tuberculosis ◽  
Mdr Tb ◽  
Time To Onset

BackgroundMultidrug-resistant tuberculosis (MDR-TB) drugs have never been associated with erythrocytosis. In Eritrea, however, several cases of incident erythrocytosis had been observed in the MDR-TB hospital. This study was aimed at exploring the association between MDR-TB drugs and secondary erythrocytosis, characterising the cases, and identifying other possible risk factors.MethodsA retrospective cohort study was conducted in Merhano National Referral MDR-TB hospital. Data were extracted from physically available clinical cards and laboratory results collected longitudinally between 23 June 2011 and 17 January 2021. Initially, univariate descriptive statistics (frequency, mean (SD), median (IQR) and range) were used as appropriate. Then, χ2 or Fisher χ2 test, and bivariate and/or multivariate Cox proportional hazard model were used to identify the predictors of incident erythrocytosis. All statistical analyses were conducted using R, and a two-sided alpha 0.05 was used to determine the statistical significance.ResultsA total of 257 patients’ medical cards were screened, and 219 were eligible for further analysis. The median age of the patients was 38 years (range: 13–90 years) and 54.8% were males. During the follow-up time, 31 (14.2%) patients developed secondary erythrocytosis yielding an incidence rate of 7.8 cases per 1000 person-months. On average, the median time to onset of the event was found to be 5-months (range: 1–24 months). Males were more likely to develop the event than females (adjusted HR=7.13, 95% CI=1.66 to 30.53), and as body weight increases by 1 kg, the likelihood of developing secondary erythrocytosis was found to increase by 7% (adjusted HR=1.07, 95% CI=1.03 to 1.10). Moreover, all cases of secondary erythrocytosis were found to be possibly associated with the MDR-TB drugs.ConclusionThe authors hypothesised that the incident erythrocytosis is possibly be associated with MDR-TB drugs, and further studies are required to substantiate this finding.

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