scholarly journals 1116. Comparison of Short-Course vs. Prolonged-Course Antimicrobial Therapy in the Management of Intra-Abdominal Infections

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S334-S334
Author(s):  
Mina Phlamon ◽  
Sarah Petite ◽  
Kelli Cole
Keyword(s):  
Logistic Regression ◽  
Antimicrobial Therapy ◽  
Clinical Cure ◽  
Antimicrobial Treatment ◽  
Multivariable Logistic Regression ◽  
Short Course ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Secondary Outcomes ◽  
Abdominal Infections

Abstract Background When managing complicated intra-abdominal infections (IAIs), the current Infectious Diseases Society of America (IDSA) guidelines recommend an antimicrobial treatment duration of 4–7 days. Although recent evidence supports this shorter course of therapy, antimicrobials are still often administered for 10–14 days due to concern for subsequent complications. The purpose of this study was to compare clinical outcomes of short-course (SC) vs. prolonged-course (PC) antimicrobial therapy in the management of IAI at our institution. Methods IRB-approved, single-center, retrospective cohort including all patients at the University of Toledo Medical Center who were admitted between January 1, 2012–June 30, 2017 with an IAI, received antimicrobials for ≥48 hours, and had at least one sign of IAI. Patients with concomitant infections at sites other than the abdomen, primary peritonitis or pancreatitis, immunocompromising conditions, or bacteremia were excluded. Primary outcome of clinical cure was compared between SC (≤7 days of antimicrobial treatment) and PC (>7 days) groups. Secondary outcomes included hospital length of stay (LOS), ICU LOS, 28-day all-cause mortality, and 30-day readmission. Multivariable logistic regression was performed to assess for factors associated with clinical cure. Results One hundred seventy-five patients were included, 73 SC and 102 PC. Baseline characteristics were similar between groups. Rate of clinical cure for SC vs. PC was 74.0% vs. 67.6% (P = 0.367). Secondary outcomes including hospital LOS (5.5 days vs. 5.8 days, P = 0.372), ICU LOS (3.0 days vs. 5.0 days, P = 0.117), 28-day all-cause mortality (4.1% vs. 2.0%, P = 0.651), and 30-day readmission (19.2% vs. 20.6%, P = 0.818) were also not significantly different. After multivariable logistic regression, the only variable independently associated with clinical cure was diverticulitis (adjusted odds ratio 0.337, 95% CI 0.133 – 0.853). Conclusion In patients with IAI, there was no significant difference observed in rates of clinical cure between SC and PC antimicrobial therapy. These results further support the IDSA recommendations for a shorter duration of therapy for patients with IAI. Disclosures All authors: No reported disclosures.

scholarly journals Antibiotic treatment duration for patients with bloodstream infection: a systematic review and meta-analysis

2020 ◽  
Author(s):  
Yuting Li ◽  
Juan Yang ◽  
Hongmei Yang ◽  
Jianxing Guo ◽  
Dong Zhang
Keyword(s):  
Systematic Review ◽  
Antibiotic Treatment ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Source Control ◽  
Short Course ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Secondary Outcomes ◽  
Long Course

Abstract Objectives: The optimal duration of therapy for primary bloodstream infection (BSI) and BSI secondary to major organ system infections has been poorly defined. A systematic review and meta-analysis was performed to evaluate the impact of short (≤10 days)and long course(>10 days) of antibiotic treatment on clinical outcomes in patients with BSI.Methods: We searched the PubMed, Cochrane, and Embase databases for randomized controlled trials(RCTs) and cohort studies from inception to the 1st of October 2020. We included studies involving patients with BSI. All authors reported our primary outcome of all-cause mortality and clearly comparing short versus long course of antibiotic treatment with clinically relevant secondary outcomes(source control and relapse). Results were expressed as odds ratio (OR) with accompanying 95% confidence interval (CI).Results: Six studies including 3593 patients were included. The primary outcome of this meta-analysis showed that there was no statistically significant difference in the all-cause mortality between two groups (OR=1.10; 95% CI, 0.82 to 1.48; P=0.52; Chi2=7.57; I2=34%) . Secondary outcomes demonstrated that there was no statistically significant difference in the source control(OR=0.82; 95% CI, 0.61 to 1.10; P=0.18; Chi2=2.68; I2=25%)and relapse(OR=1.20; 95%CI,0.71 to 2.01; P=0.49; Chi2=0.26; I2=0%) between two groups. Conclusions: Short course of antibiotic treatment is not associated with either an increased risk of mortality or an increased odds of relapse compared with longer antibiotic treatment course for BSI. Furthermore, short course of antibiotic therapy is non-inferior to long course in terms of source control. Further large-scale RCTs are still required to confirm these results.

scholarly journals Comparison of laparoscopic and hand-assisted laparoscopic nephrectomy for inflammatory renal disease: which is the preferred approach?

2021 ◽  
Vol 13 ◽  
pp. 175628722098404
Author(s):  
Xudong Guo ◽  
Hanbo Wang ◽  
Yuzhu Xiang ◽  
Xunbo Jin ◽  
Shaobo Jiang
Keyword(s):  
Logistic Regression ◽  
Renal Disease ◽  
Complication Rate ◽  
Adverse Outcomes ◽  
Laparoscopic Nephrectomy ◽  
Multivariable Logistic Regression Analysis ◽  
Invasive Approach ◽  
Intraoperative Complication ◽  
Multivariable Logistic Regression ◽  
Significant Difference

Aims: Management of inflammatory renal disease (IRD) can still be technically challenging for laparoscopic procedures. The aim of the present study was to compare the safety and feasibility of laparoscopic and hand-assisted laparoscopic nephrectomy in patients with IRD. Patients and methods: We retrospectively analyzed the data of 107 patients who underwent laparoscopic nephrectomy (LN) and hand-assisted laparoscopic nephrectomy (HALN) for IRD from January 2008 to March 2020, including pyonephrosis, renal tuberculosis, hydronephrosis, and xanthogranulomatous pyelonephritis. Patient demographics, operative outcomes, and postoperative recovery and complications were compared between the LN and HALN groups. Multivariable logistic regression analysis was conducted to identify the independent predictors of adverse outcomes. Results: Fifty-five subjects in the LN group and 52 subjects in the HALN group were enrolled in this study. In the LN group, laparoscopic nephrectomy was successfully performed in 50 patients (90.9%), while four (7.3%) patients were converted to HALN and one (1.8%) case was converted to open procedure. In HALN group, operations were completed in 51 (98.1%) patients and conversion to open surgery was necessary in one patient (1.9%). The LN group had a shorter median incision length (5 cm versus 7 cm, p < 0.01) but a longer median operative duration (140 min versus 105 min, p < 0.01) than the HALN group. There was no significant difference in blood loss, intraoperative complication rate, postoperative complication rate, recovery of bowel function, and hospital stay between the two groups. Multivariable logistic regression revealed that severe perinephric adhesions was an independent predictor of adverse outcomes. Conclusion: Both LN and HALN appear to be safe and feasible for IRD. As a still minimally invasive approach, HALN provided an alternative to IRD or when conversion was needed in LN.

Abstract P258: The Use Of Ace Inhibitors And Angiotensin Receptor Blockers Is Associated With Decreased Mortality And Increased Hospitalization Rate In Covid-19 Patients

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Aaron Douen ◽  
Jeremy Oh ◽  
Wesley Romney ◽  
Ryan Panetti ◽  
Prakash Ramdass ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Angiotensin Receptor Blockers ◽  
Hospitalization Rate ◽  
Host Cells ◽  
Channel Blockers ◽  
Multivariate Logistic Regression ◽  
Converting Enzyme Inhibitors ◽  
All Cause Mortality ◽  
Receptor Blockers ◽  
Secondary Outcomes

Introduction: Angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are well known for upregulating ACE2 receptors. SARS-Cov-2 (COVID-19) infection utilizes the ACE2 receptor for proliferation and infection of host cells. Hypothesis: We hypothesize that the use of ACEI/ARBs will lead to a higher mortality and hospitalization rate among COVID-19 infected patients. Methods: The electronic health database at a public hospital in New York City was queried retrospectively for patients 18 years and older with a positive test for COVID-19 between 3/1/2020 - 4/1/2021. We examined baseline characteristics including comorbidities and whether they were prescribed ACEI/ARBs versus other medications including beta-blockers, calcium channel blockers, thiazides, or hydralazine. We categorized patients based on ACEI/ARB. The primary outcomes were all-cause mortality and hospitalization. The secondary outcomes were acute kidney injury, ventricular arrhythmia, myocardial infarction, heart failure, and intubation. We adjusted for comorbidities using multivariate logistic regression. Results: We identified 23,068 patients positive for SARS-CoV-2; 1,385 on ACEI/ARBs and 21,683 not on ACE/ARBs. The mean age in years was 65.90 +- 14.35 (SEM 0.386) and 44.01+-16.76, (SEM 0.114) for ACEI/ARB and non-ACEI/ARB respectively (p<0.001). The incidence of all cause mortality and hospitalization rate were significantly greater in the ACEI/ARB group. However, when adjusted for comorbidities using multivariate logistic regression, OR for mortality was 0.41 (CI 0.32-0.52, p<0.001) and for hospitalization was 4.12 (CI 3.49-4.86 p<0.001). For the secondary outcomes, non-ACEI/ARB patients had significantly increased unadjusted odds of all outcomes (p<0.001), except for ventricular tachycardia (p<0.618) and intubation (p< 0.214). Conclusion: Patients in the ACEI/ARB group demonstrated significantly lower mortality and increased hospitalization rates. Increased hospitalization may be due to more comorbidities. These results highlight the importance of continuing the use of ACEI and ARBs in COVID-19 patients for treatment of comorbidities and cardioprotective effects.

scholarly journals The effect of additional antimicrobial therapy on the outcomes of patients with idiopathic pulmonary fibrosis: a systematic review and meta-analysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ching-Yi Chen ◽  
Chao-Hsien Chen ◽  
Cheng-Yi Wang ◽  
Chih-Cheng Lai ◽  
Chien-Ming Chao ◽  
...  
Keyword(s):  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Usual Care ◽  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Meta Analysis ◽  
Lung Function Decline ◽  
Increased Risk ◽  
Significant Difference ◽  
All Cause Mortality

Abstract Background The effect of additional antimicrobial agents on the clinical outcomes of patients with idiopathic pulmonary fibrosis (IPF) is unclear. Methods We performed comprehensive searches of randomized control trials (RCTs) that compared the clinical efficacy of additional antimicrobial agents to those of placebo or usual care in the treatment of IPF patients. The primary outcome was all-cause mortality, and the secondary outcomes were changes in forced vital capacity (FVC), diffusing capacity of the lung for carbon monoxide (DLCO), and the risk of adverse events (AEs). Results Four RCTs including a total of 1055 patients (528 receiving additional antibiotics and 527 receiving placebo or usual care) were included in this meta-analysis. Among the study group, 402 and 126 patients received co-trimoxazole and doxycycline, respectively. The all-cause mortality rates were 15.0% (79/528) and 14.0% (74/527) in the patients who did and did not receive additional antibiotics, respectively (odds ratio [OR] 1.07; 95% confidence interval [CI] 0.76 to 1.51; p = 0.71). No significant difference was observed in the changes in FVC (mean difference [MD], 0.01; 95% CI − 0.03 to 0.05; p = 0.56) and DLCO (MD, 0.05; 95% CI − 0.17 to 0.28; p = 0.65). Additional use of antimicrobial agents was also associated with an increased risk of AEs (OR 1.65; 95% CI 1.19 to 2.27; p = 0.002), especially gastrointestinal disorders (OR 1.54; 95% CI 1.10 to 2.15; p = 0.001). Conclusions In patients with IPF, adding antimicrobial therapy to usual care did not improve mortality or lung function decline but increased gastrointestinal toxicity.

Short versus prolonged courses of antimicrobial therapy for patients with uncomplicated Pseudomonas aeruginosa bloodstream infection: a retrospective study

2021 ◽  
Author(s):  
Moonsuk Bae ◽  
Yunseo Jeong ◽  
Seongman Bae ◽  
Min Jae Kim ◽  
Yong Pil Chong ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Bloodstream Infection ◽  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Propensity Score Analysis ◽  
Tertiary Care ◽  
Care Hospital ◽  
Short Course ◽  
Significant Difference

Abstract Background The optimal duration of antimicrobial therapy for uncomplicated Pseudomonas aeruginosa bloodstream infection (BSI) is unknown. We compared the outcomes of short and prolonged courses of antimicrobial therapy in adults with uncomplicated pseudomonal BSI. Methods All patients with uncomplicated P. aeruginosa BSI admitted at a tertiary-care hospital from April 2010 to April 2020 were included. We compared the primary outcome (a composite of the rate of recurrent P. aeruginosa infection and mortality within 30 days after discontinuing antimicrobial therapy) among patients who underwent short (7‒11 days) and prolonged (12‒21 days) courses of antimicrobial therapy using propensity score analysis with the inverse probability of treatment weighting (IPTW) method. Results We evaluated 1477 patients with P. aeruginosa BSI; of them, 290 met the eligibility criteria who received antimicrobial agents with in vitro activity, including 97 (33%) who underwent short-course therapy [median of 9 (IQR = 8‒11) days] and 193 (67%) who underwent prolonged-course therapy [median of 15 (IQR = 14‒18) days]. We found no significant difference in the risk of recurrence or 30 day mortality between the prolonged-course and short-course groups [n = 30 (16%) versus n = 11 (11%); IPTW-adjusted HR = 0.68, 95% CI = 0.34 − 1.36, P = 0.28]. The prolonged-course therapy did not significantly reduce the risk of the recurrence of P. aeruginosa infection within 180 days compared with short-course therapy [n = 37 (19%) versus n = 12 (12%); IPTW-adjusted HR = 0.57, 95% CI = 0.29 − 1.10, P = 0.09]. Conclusions Short-course antimicrobial therapy could be as effective as prolonged-course therapy for uncomplicated P. aeruginosa BSI.

scholarly journals Impact of vanA-Positive Enterococcus faecium Exhibiting Diverse Susceptibility Phenotypes to Glycopeptides on 30-Day Mortality of Patients with a Bloodstream Infection

2020 ◽  
Vol 64 (7) ◽  
Author(s):  
Dokyun Kim ◽  
Eun-Jeong Yoon ◽  
Jun Sung Hong ◽  
Hyukmin Lee ◽  
Kyeong Seob Shin ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Mortality Rate ◽  
Bloodstream Infection ◽  
Clinical Outcomes ◽  
Enterococcus Faecium ◽  
Rank Test ◽  
Content Type ◽  
Multicenter Observational Study ◽  
Multivariable Logistic Regression ◽  
Significant Difference

ABSTRACT This study was performed to evaluate the impacts of vanA positivity of Enterococcus faecium exhibiting diverse susceptibility phenotypes to glycopeptides on clinical outcomes in patients with a bloodstream infection (BSI) through a prospective, multicenter, observational study. A total of 509 patients with E. faecium BSI from eight sentinel hospitals in South Korea during a 2-year period were enrolled in this study. Risk factors of the hosts and causative E. faecium isolates were assessed to determine associations with the 30-day mortality of E. faecium BSI patients via multivariable logistic regression analyses. The vanA gene was detected in 35.2% (179/509) of E. faecium isolates; 131 E. faecium isolates exhibited typical VanA phenotypes (group vanA-VanA), while the remaining 48 E. faecium isolates exhibited atypical phenotypes (group vanA-atypical), which included VanD (n = 43) and vancomycin-variable phenotypes (n = 5). A multivariable logistic regression indicated that vanA positivity of causative pathogens was independently associated with the increased 30-day mortality rate in the patients with E. faecium BSI; however, there was no significant difference in survival rates between the patients of the vanA-VanA and vanA-atypical groups (log rank test, P = 0.904). A high 30-day mortality rate was observed in patients with vanA-positive E. faecium BSIs, and vanA positivity of causative E. faecium isolates was an independent risk factor for early mortality irrespective of the susceptibility phenotypes to glycopeptides; thus, intensified antimicrobial stewardship is needed to improve the clinical outcomes of patients with vanA-positive E. faecium BSI.

scholarly journals Is There a Significant Difference in Acute Kidney Injury Incidence Among Patients Treated with Vancomycin Combined with Cefepime or Meropenem?

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S338-S338
Author(s):  
W Cliff Rutter ◽  
David S Burgess
Keyword(s):  
Logistic Regression ◽  
Calcineurin Inhibitors ◽  
Kidney Injury ◽  
Injury Incidence ◽  
University Of Kentucky ◽  
Multivariable Logistic Regression ◽  
Significant Difference ◽  
End Stage ◽  
Therapeutic Alternatives ◽  
The University

Abstract Background Acute kidney injuries (AKIs) are common among patients receiving concomitant vancomycin (VAN) and piperacillin-tazobactam, especially compared with cefepime (FEP) with vancomycin. It is unknown if there is a significant difference between therapeutic alternatives to piperacillin-tazobactam. We hypothesized that AKI rates would be similar in patients treated with FEP+VAN and meropenem (MEM)+VAN. Methods Demographic and clinical data were abstracted from the University of Kentucky Center for Clinical and Translational Sciences Enterprise Data Trust from 2008 through 2015. Patients were included if they received VAN and FEP or MEM in combination for ≥48 hours. Patients with baseline CKD and creatinine clearance &lt;30 mL/minute were excluded. AKI was defined as meeting any of the Risk, Injury, Failure, Loss, End-stage (RIFLE) criteria. Basic descriptive statistics were performed in addition to bivariable and multivariable logistic regression for AKI. Results In total, 3662 patients were included in this study with 3366 patients receiving FEP+VAN and 296 receiving MEM+VAN. Demographic characteristics were evenly distributed among both groups, with the exception of Charlson comorbidity index (MEM+VAN 4 [2–6] vs. 3 [1–6], P = 0.0002), and exposure to aminoglycosides (MEM+VAN 18.2% vs. 13.2%, P = 0.02) and calcineurin inhibitors (MEM+VAN 6.1% vs. 2.7%, P = 0.002). AKI incidence was similar between group (MEM+VAN 12.8% vs. FEP+VAN 10.8%, P = 0.33). After multivariable logistic regression, there was no significant increase in AKI odds with MEM+VAN compared with FEP+VAN (adjusted odds ratio = 1.02; 95% CI 0.67–1.50). Factors associated with increased AKI odds included: male gender, increased baseline comorbidity, age &gt;80, increased duration of antimicrobial therapy, hypotension, increased baseline renal function, and exposure to aminoglycosides, amphotericin B, non-steroidal anti-inflammatory drugs, loop diuretics, or vasopressors. Conclusion No difference in AKI incidence was found between patients treated with MEM+VAN or FEP+VAN. Other clinical factors, aside from AKI potential, should be considered when choosing between alternatives to piperacillin-tazobactam combined with vancomycin. Disclosures All authors: No reported disclosures.

scholarly journals The Effect of Cognitive Training in a Day Care Center in Patients with Early Alzheimer’s Disease Dementia: A Retrospective Study

2020 ◽  
Vol 17 (8) ◽  
pp. 829-834
Author(s):  
Hyuk Sung Kwon ◽  
Ha-rin Yang ◽  
Kyungtaek Yun ◽  
Jong Sook Baek ◽  
Young Un Kim ◽  
...  
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Logistic Regression ◽  
Training Program ◽  
Cognitive Training ◽  
Day Care ◽  
Clinical Care ◽  
Multivariable Logistic Regression ◽  
Significant Difference ◽  
Alzheimer’S Disease Dementia

Objective This study aimed to evaluate the effect of cognitive training programs on the progression of dementia in patients with early stage Alzheimer’s disease dementia (ADD) at the day care center.Methods From January 2015 to December 2018, a total of 119 patients with early ADD were evaluated. All subjects were classified into two groups according to participate in cognitive training program in addition to usual standard clinical care. Changes in scores for minimental status examination-dementia screening (MMSE-DS) and clinical dementia rating-sum of boxes (CDR-SOB) during the 12 months were compared between two groups. Multivariable logistic regression analyses were performed.Results As compared to case-subjects (n=43), the MMSE-DS and CDR-SOB scores were significantly worse at 12 months in the control-subjects (n=76). A statistically significant difference between the two groups was observed due to changes in MMSE-DS (p=0.012) and CDR-SOB (p<0.001) scores. Multivariable logistic regression analysis showed that the cognitive training program (odds ratio and 95% confidence interval: 0.225, 0.070–0.725) was independently associated with less progression of ADD.Conclusion The cognitive training program was associated with benefits in maintaining cognitive function for patients with earlystage ADD that were receiving medical treatment.

scholarly journals Outcomes of Outpatient Parenteral Antimicrobial Therapy With Ceftriaxone for Methicillin-Susceptible Staphylococcus aureus Bloodstream Infections—A Single-Center Observational Study

2020 ◽  
Vol 7 (9) ◽  
Author(s):  
Yasir Hamad ◽  
Lee Connor ◽  
Thomas C Bailey ◽  
Ige A George
Keyword(s):  
Staphylococcus Aureus ◽  
Antimicrobial Therapy ◽  
Adverse Outcome ◽  
Bloodstream Infections ◽  
Intensive Care Unit Care ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Mssa Infection ◽  
Single Center Observational Study

Abstract Background Staphylococcus aureus bloodstream infections (BSIs) are associated with significant morbidity and mortality. Ceftriaxone is convenient for outpatient parenteral antimicrobial therapy (OPAT), but data for this indication are limited. Methods Adult patients with methicillin-susceptible Staphylococcus aureus (MSSA) BSI discharged on OPAT with cefazolin, oxacillin, or ceftriaxone for at least 7 days were included. We compared outcomes of ceftriaxone vs either oxacillin or cefazolin. Ninety-day all-cause mortality, readmission due to MSSA infection, and microbiological failure were examined as a composite outcome and compared among groups. Rates of antibiotic switches due to intolerance were assessed. Results Of 243 patients included, 148 (61%) were discharged on ceftriaxone and 95 (39%) were discharged on either oxacillin or cefazolin. The ceftriaxone group had lower rates of intensive care unit care, endocarditis, and shorter duration of bacteremia, but higher rates of cancer diagnoses. There was no significant difference in the composite adverse outcome in the oxacillin or cefazolin group vs the ceftriaxone group (18 [19%] vs 31 [21%]; P = .70), comprising microbiological failure (6 [6.3%] vs 9 [6.1%]; P = .94), 90-day all-cause mortality (7 [7.4%] vs 15 [10.1%]; P = .46), and readmission due to MSSA infection (10 [10.5%] vs 13 [8.8%]; P = .65). Antibiotic intolerance necessitating a change was similar between the 2 groups (4 [4.2%] vs 6 [4.1%]; P = .95). Conclusions For patients with MSSA BSI discharged on OPAT, within the limitations of the small numbers and retrospective design we did not find a significant difference in outcomes for ceftriaxone therapy when compared with oxacillin or cefazolin therapy.

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