scholarly journals 1045. A Multicenter Propensity Score-Adjusted Retrospective Study for Comparison of the Outcome of Treatment With Third-Generation Cephalosporin vs. Broad-Spectrum Antibiotics for Enterobacter Bacteremia

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S312-S312
Author(s):  
Satoshi Hayano ◽  
Shungo Yamamoto ◽  
Ryota Hase ◽  
Akihiro Toguchi ◽  
Yoshihito Otsuka ◽  
...  
Keyword(s):  
Propensity Score ◽  
Broad Spectrum ◽  
Antimicrobial Therapy ◽  
Resistant Strain ◽  
Propensity Score Analysis ◽  
Risk Difference ◽  
Third Generation ◽  
Broad Spectrum Antibiotics ◽  
Score Analysis ◽  
Definitive Therapy

Abstract Background Enterobacter spp. can develop resistance during prolonged therapy with third-generation cephalosporins (3GC: ceftriaxone, cefotaxime, or ceftazidime) because of derepression of AmpC β-lactamase. However, the clinical significance of this phenomena remains undetermined. This study aims to assess the outcome of patients with 3GC-susceptible Enterobacter bacteremia (EB) who received definite therapy with 3GC or broad-spectrum antibiotics (BSA) using propensity score analysis. Methods In this retrospective, cohort study conducted at two tertiary care hospitals in Japan, we determined consecutive patients with EB identified from the laboratory databases between January 2010 and December 2017. We enrolled patients with 3GC-susceptible EB treated with 3GC or BSA (defined as fourth-generation cephalosporins, carbapenems, and piperacillin/tazobactam) as definitive therapy. The primary outcome was 28-day mortality. The secondary outcome was the emergence of antimicrobial-resistant strain during antimicrobial therapy. We compared outcomes using the propensity scores and inverse-probability-weighting (IPW) adjustment to decrease the confounding by indication. Results We identified 320 patients with EB; of these, 191 cases were eligible (86 treated with 3GC and 105 treated with BSA). All the measured covariates were well balanced after the IPW adjustment. We observed no significant differences in the unadjusted mortality [5.8% in the 3GC group vs. 13.3% in the BSA group; risk difference, −7.5%; 95% confidence interval (CI): −15.7–0.6; P = 0.09], and the IPW-adjusted mortality (5.1% vs. 9.4%; risk difference −4.3%; 95% CI: −12.2–3.5; P = 0.3) between the groups. The results of the propensity score-matched analysis and sensitivity analysis were similar. Furthermore, we did not observe the emergence of antimicrobial resistance during antimicrobial therapy in both groups. Conclusion Definitive therapy with 3GC for susceptible EB was not associated with an increased risk of the 28-day mortality after adjustment for potential confounders with the propensity score analysis or with the emergence of antimicrobial-resistant strain. Disclosures All authors: No reported disclosures.

scholarly journals Hemodialysis is a strong risk factor for post-endoscopic sphincterotomy bleeding in patients with choledocholithiasis

2018 ◽  
Vol 06 (05) ◽  
pp. E568-E574 ◽  
Author(s):  
So Nakaji ◽  
Nobuto Hirata ◽  
Hiroki Matsui ◽  
Toshiyasu Shiratori ◽  
Masayoshi Kobayashi ◽  
...  
Keyword(s):  
Risk Factor ◽  
Propensity Score ◽  
Endoscopic Sphincterotomy ◽  
Outcome Measure ◽  
Propensity Score Analysis ◽  
Univariate Analysis ◽  
Risk Difference ◽  
Secondary Outcome ◽  
Bleeding Rate ◽  
Score Analysis

Abstract Background and study aims Hemodialysis (HD) is considered one of the risk factors for post-endoscopic sphincterotomy (ES) bleeding. Therefore, we conducted a retrospective study to evaluate HD as a risk factor for post-ES bleeding in patients with choledocholithiasis. Patients and methods We used the post-ES bleeding rate as the main outcome measure. To evaluate the influence of HD on the risk of post-ES bleeding, logistic regression and propensity score analyses were conducted. In addition, univariate analysis-based comparisons of various clinical parameters (as secondary outcome measures) were performed between the patients in the HD and non-HD groups that experienced post-ES bleeding. Results A total of 1518 patients were enrolled. In the multivariate analysis, a platelet count of < 50,000, anticoagulant therapy, bleeding during ES, and HD were found to be significantly associated with post-ES bleeding (odds ratio [OR]: 35.30, 95 % confidence interval [CI]: 3.81 – 328.00; OR: 4.39, 95 % CI: 1.53 – 12.60; OR: 4.28, 95 % CI: 2.30 – 7.97; and OR: 13.30, 95 % CI: 5.78 – 30.80, respectively). Propensity score matching created 28 matched pairs. Propensity score analysis showed that the risk difference between the groups was 0.214 (95 % CI: 0.022 – 0.407). In a comparison between the patients in the HD and non-HD groups that suffered post-ES bleeding, it was found that the post-ES bleeding was significantly more severe in the HD group (p = 0.033), and massive blood transfusions and long periods of hospitalization were more frequently required in the HD group (p = 0.008 and p < 0.001, respectively). Conclusion HD is an independent risk factor for post-ES bleeding and makes post-ES bleeding more serious.

Efficacy of variceal embolisation in patients with TIPS implantation: a propensity score analysis

2018 ◽  
Vol 56 (01) ◽  
pp. E2-E89
Author(s):  
M Giesler ◽  
D Bettinger ◽  
M Rössle ◽  
R Thimme ◽  
M Schultheiss
Keyword(s):  
Propensity Score ◽  
Propensity Score Analysis ◽  
Score Analysis

scholarly journals Morbidity and mortality of lobectomy or pneumonectomy after neoadjuvant treatment: an analysis from the ESTS database

2019 ◽  
Author(s):  
Alessandro Brunelli ◽  
Gaetano Rocco ◽  
Zalan Szanto ◽  
Pascal Thomas ◽  
Pierre Emmanuel Falcoz
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Propensity Score ◽  
Propensity Score Analysis ◽  
Bronchopleural Fistula ◽  
Neoadjuvant Treatment ◽  
Mortality Rates ◽  
Induction Treatment ◽  
Score Analysis ◽  
Cardiopulmonary Complications ◽  
Lung Resections

Abstract OBJECTIVES To evaluate the postoperative complications and 30-day mortality rates associated with neoadjuvant chemotherapy before major anatomic lung resections registered in the European Society of Thoracic Surgeons (ESTS) database. METHODS Retrospective analysis on 52 982 anatomic lung resections registered in the ESTS database (July 2007–31 December 2017) (6587 pneumonectomies and 46 395 lobectomies); 5143 patients received neoadjuvant treatment (9.7%) (3993 chemotherapy alone and 1150 chemoradiotherapy). To adjust for possible confounders, a propensity case-matched analysis was performed. The postoperative outcomes (morbidity and 30-day mortality) of matched patients with and without induction treatment were compared. RESULTS 8.2% of all patients undergoing lobectomies and 20% of all patients undergoing pneumonectomies received induction treatment. Lobectomy analysis: propensity score analysis yielded 3824 pairs of patients with and without induction treatment. The incidence of cardiopulmonary complications was higher in the neoadjuvant group (626 patients, 16% vs 446 patients, 12%, P < 0.001), but 30-day mortality rates were similar (71 patients, 1.9% vs 75 patients, 2.0%, P = 0.73). The incidence of bronchopleural fistula and prolonged air leak >5 days were similar between the 2 groups (neoadjuvant: 0.5% vs 0.4%, P = 0.87; 9.2% vs 9.9%, P = 0.27). Pneumonectomy analysis: propensity score analysis yielded 1312 pairs of patients with and without induction treatment. The incidence of cardiopulmonary complications was higher in the treated patients compared to those without neoadjuvant treatment (neoadjuvant 275 cases, 21% vs 18%, P = 0.030). However, the 30-day mortality was similar between the matched groups (neoadjuvant 68 cases, 5.2% vs 5.3%, P = 0.86). Finally, the incidence of bronchopleural fistula was also similar between the 2 groups (neoadjuvant 1.8% vs 1.4%, P = 0.44). CONCLUSIONS Neoadjuvant chemotherapy is not associated with an increased perioperative risk after either lobectomy or pneumonectomy, warranting a more liberal use of this approach for patients with locally advanced operable lung cancer.

Sign in / Sign up

Export Citation Format

Share Document