scholarly journals 1049. Outcome and Impact of Empirical Antimicrobial Treatment in Bacteraemia With Bacteroides Species; A Retrospective Cohort Study in a Region of Southern Sweden

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S313-S313
Author(s):  
Johan Tham ◽  
Karolina Kalin ◽  
Fredrik Resman ◽  
Karin Holm
Keyword(s):  
Cohort Study ◽  
Antibiotic Treatment ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Early Recognition ◽  
Antimicrobial Treatment ◽  
Bacteroides Species ◽  
Appropriate Treatment ◽  
Severe Infections ◽  
Anaerobic Infections

Abstract Background Anaerobic infections are an important cause of bacteremia and severe Infections. Due to increasing extended spectrum β-lactamase resistance (ESBL), the treatment recommendations for anaerobic infections in Sweden have changed during the past ten years. The effects of anaerobe resistance and outcome for patients with anaerobe infections is unclear. Methods A retrospective cohort study was conducted in patients with bacteraemia due to Bacteroides species in the Region of Skåne between 2011 and 2015. Data on patients were reviewed from medical and microbiological records and we determined the factors associated with 28-day mortality using a multivariate regression model. Results Data on 454 patients were reviewed from medical and microbiological records and 389 (median age, 76 years; male, 54%) met the inclusion criteria. The 28-day all-cause mortality rate was 19% (72/389). Inadequate empirical antibiotic therapy occurred among 182 (47%) patients, and we found a trend toward that inadequate antibiotic treatment increased the 28-day mortality (P = 0.055). The frequency of bacteraemia with Bacteroides increased during the period of time and Bacteroides fragilis was the most common bacteria, 55% (212/389). The resistance against piperacillin/tazobactam was higher than in many other studies and among the different Bacteroides isolates that were resistant to piperacillin/tazobactam, Bacteroides thetaiotamicron was the most prevalent with 60% (50/83) being resistant. Piperacillin/tazobactam was the frequently used antimicrobial agent against Bacteroides infections and the utilization was increasing. We did not find any resistance among the Bacteroides isolates against metronidazole and only three isolates were resistant against carbapenems. Conclusion Anaerobe resistance is an increasing issue and especially against the most common antibiotic treatment, piperacillin/tazobactam. Early recognition and appropriate treatment is important to avoid proliferation of these increasing bacteria since inadequate treatment increased the mortality. Disclosures All authors: No reported disclosures.

Long-Term Outcome of Patients with Acute Cholecystitis Receiving Antibiotic Treatment: A Retrospective Cohort Study

2013 ◽  
Vol 38 (2) ◽  
pp. 347-354 ◽  
Author(s):  
Chih-Hung Wang ◽  
Hao-Chang Chou ◽  
Kao-Lang Liu ◽  
Wan-Ching Lien ◽  
Hsiu-Po Wang ◽  
...  
Keyword(s):  
Cohort Study ◽  
Acute Cholecystitis ◽  
Antibiotic Treatment ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Term Outcome ◽  
Long Term Outcome

scholarly journals The Effect of Antibiotic Treatment of Early Childhood Shigellosis on Long-Term Prevalence of Attention Deficit/Hyperactivity Disorder

Children ◽  
2021 ◽  
Vol 8 (10) ◽  
pp. 880
Author(s):  
Yair Sadaka ◽  
Judah Freedman ◽  
Shai Ashkenazi ◽  
Shlomo Vinker ◽  
Avivit Golan-Cohen ◽  
...  
Keyword(s):  
Attention Deficit Hyperactivity Disorder ◽  
Early Childhood ◽  
Cohort Study ◽  
Antibiotic Treatment ◽  
Attention Deficit ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Hyperactivity Disorder ◽  
Increased Risk

It has recently been shown that children with early shigellosis are at increased risk of attention deficit/hyperactivity disorder (ADHD). This study aimed to evaluate the association between antibiotic treatment of shigellosis with long-term ADHD rates. A retrospective cohort study was conducted that included all the Leumit Health Services (LHS) enrollees aged 5–18 years between 2000–2018 with a documented Shigella-positive gastroenteritis before the age of 3 years. Of the 5176 children who were positive for Shigella gastroenteritis before the age of 3 years, 972 (18.8%) were treated with antibiotics early (<5 days), 250 (4.8%) were treated late (≥5 days), and 3954 children (76.4%) were not prescribed antibiotics. Late antibiotic treatment was associated with significantly increased rates of ADHD (adjusted OR = 1.61; 95% CI, 1.1–2.3). Early treatment with antibiotics was not associated with increased ADHD rates (adjusted OR = 1.02; 95% CI, 0.8–1.3). In conclusion, late antibiotic treatment of early childhood shigellosis was associated with increased rates of ADHD.

scholarly journals Adherence to self-administered biologic disease-modifying antirheumatic drugs across health-system specialty pharmacies

2021 ◽  
Author(s):  
Autumn D Zuckerman ◽  
Josh DeClercq ◽  
Leena Choi ◽  
Nicole Cowgill ◽  
Kate McCarthy ◽  
...  
Keyword(s):  
Cohort Study ◽  
Health System ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Disease Modifying Antirheumatic Drugs ◽  
Antirheumatic Drugs ◽  
Pharmacy Claims ◽  
Appropriate Treatment ◽  
Treatment Gaps ◽  
Disease Modifying

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Adherence to self-administered biologic disease-modifying antirheumatic drugs (bDMARDs) is necessary for therapeutic benefit. Health-system specialty pharmacies (HSSPs) have reported high adherence rates across several disease states; however, adherence outcomes in rheumatoid arthritis (RA) populations have not yet been established. Methods We performed a multisite retrospective cohort study including patients with RA and 3 or more documented dispenses of bDMARDs from January through December 2018. Pharmacy claims were used to calculate proportion of days covered (PDC). Electronic health records of patients with a PDC of &lt;0.8 were reviewed to identify reasons for gaps in pharmacy claims (true nonadherence or appropriate treatment holds). Outcomes included median PDC across sites, reasons for treatment gaps in patients with a PDC of &lt;0.8, and the impact of adjusting PDC when accounting for appropriate therapy gaps. Results There were 29,994 prescriptions for 3,530 patients across 20 sites. The patient cohort was mostly female (75%), with a median age of 55 years (interquartile range [IQR], 42-63 years). The original(ie, prereview) median PDC was 0.94 (IQR, 0.83-0.99). Upon review, 327 patients had no appropriate treatment gaps identified, 6 patients were excluded due to multiple unquantifiable appropriate gaps, and 420 patients had an adjustment in the PDC denominator due to appropriate treatment gaps (43 instances of days’ supply adjusted based on discordant days’ supply information between prescriptions and physician administration instructions, 11 instances of missing fills added, and 421 instances of clinically appropriate treatment gaps). The final median PDC after accounting for appropriate gaps in therapy was 0.95 (IQR, 0.87-0.99). Conclusion This large, multisite retrospective cohort study was the first to demonstrate adherence rates across several HSSPs and provided novel insights into rates and reasons for appropriate gaps in therapy.

scholarly journals Use of long-term antibiotic treatment in COPD patients in the UK: a retrospective cohort study

2013 ◽  
Vol 22 (3) ◽  
pp. 271-277 ◽  
Author(s):  
Gareth Dean Russell James ◽  
Irene Petersen ◽  
Irwin Nazareth ◽  
Jadwiga A Wedzicha ◽  
Gavin C Donaldson
Keyword(s):  
Cohort Study ◽  
Antibiotic Treatment ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Copd Patients ◽  
The Uk

Early Recognition and Treatment of Sepsis After the Addition of Lactate to the Laboratory’s Critical Result Call List

2016 ◽  
Vol 33 (2) ◽  
pp. 111-115 ◽  
Author(s):  
Hani I. Kuttab ◽  
Ethan Sterk ◽  
Megan A. Rech ◽  
Trac Nghiem ◽  
Burak Bahar ◽  
...  
Keyword(s):  
Severe Sepsis ◽  
Cohort Study ◽  
Hospital Mortality ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Early Recognition ◽  
Intravenous Fluids ◽  
Time To Antibiotics ◽  
Group 2 ◽  
Group 1

Purpose: Screening of patients with sepsis is needed to increase recognition and allow for earlier interventions. There is no consensus on whether the addition of lactate to the critical result laboratory’s call list should be a standard practice. Materials and Methods: This was a retrospective cohort study that compared management and outcomes of patients with sepsis having lactate ≥4 mmol/L before (group 1) and after (group 2) the addition of a critical result threshold of lactate of ≥4 mmol/L to the critical result laboratory’s call list and its effects on time to antibiotics and intravenous fluids (IVFs). Results: One hundred twenty-one patients were included. Lactate was higher in group 1 (7.0 ± 4.3 vs 5.6 ± 2.0, P = 0.03). More patients in group 2 received hydrocortisone (1.9% vs 22.4%, P = .001). Hospital mortality, 30-day mortality, and 90-day mortality were significantly lower in group 2 (59.3% vs 32.8%, P = .003; 68.5% vs 37.3%, P ≤ .001; 68.5% vs 41.8%, P = .002). There were no significant differences in total volume of IVFs (2400.8 ± 1720.0 vs 2483.7 ± 2155.7, P = 0.83), time to start IVFs (184.0 ± 283.2 vs 115.6 ± 190.5, P = 0.27), or antibiotics (184.8 ± 187.1 vs 133.7 ± 137.4, P = 0.16). Conclusion: Addition of lactate to the critical result laboratory’s call list did not lead to a statistically significant improvement in time to IVFs or antibiotics, although the average time to antibiotics and IVFs decreased by 51.1 and 68.4 minutes, respectively. Hospital mortality, 30-day mortality, and 90-day mortality were lower in group 2, which may be, in part, due to increased recognition of severe sepsis by critical result notification and earlier intervention.

scholarly journals Duration of Antibiotic Therapy for Critically Ill Patients with Bloodstream Infections: A Retrospective Cohort Study

2013 ◽  
Vol 24 (3) ◽  
pp. 129-137 ◽  
Author(s):  
Thomas C Havey ◽  
Robert A Fowler ◽  
Ruxandra Pinto ◽  
Marion Elligsen ◽  
Nick Daneman
Keyword(s):  
Cohort Study ◽  
Bloodstream Infection ◽  
Critically Ill ◽  
Antibiotic Treatment ◽  
Retrospective Cohort Study ◽  
Critically Ill Patients ◽  
Retrospective Cohort ◽  
Bloodstream Infections ◽  
Prolonged Treatment ◽  
Care Hospital

BACKGROUND: The optimal duration of antibiotic treatment for bloodstream infections is unknown and understudied.METHODS: A retrospective cohort study of critically ill patients with bloodstream infections diagnosed in a tertiary care hospital between March 1, 2010 and March 31, 2011 was undertaken. The impact of patient, pathogen and infectious syndrome characteristics on selection of shorter (≤10 days) or longer (>10 days) treatment duration, and on the number of antibiotic-free days, was examined. The time profile of clinical response was evaluated over the first 14 days of treatment. Relapse, secondary infection and mortality rates were compared between those receiving shorter or longer treatment.RESULTS: Among 100 critically ill patients with bloodstream infection, the median duration of antibiotic treatment was 11 days, but was highly variable (interquartile range 4.5 to 17 days). Predictors of longer treatment (fewer antibiotic-free days) included foci with established requirements for prolonged treatment, underlying respiratory tract focus, and infection withStaphylococcus aureusorPseudomonasspecies. Predictors of shorter treatment (more antibiotic-free days) included vascular catheter source and bacteremia with coagulase-negative staphylococci. Temperature improvements plateaued after the first week; white blood cell counts, multiple organ dysfunction scores and vasopressor dependence continued to decline into the second week. Among 72 patients who survived to 10 days, clinical outcomes were similar between those receiving shorter and longer treatment.CONCLUSION: Antibiotic treatment durations for patients with bloodstream infection are highly variable and often prolonged. A randomized trial is needed to determine the duration of treatment that will maximize cure while minimizing adverse consequences of antibiotics.

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