scholarly journals Pharmacological and Patient-Specific Response Determinants in Patients with Hospital-Acquired Pneumonia Treated with Tigecycline

2011 ◽  
Vol 56 (2) ◽  
pp. 1065-1072 ◽  
Author(s):  
Sujata M. Bhavnani ◽  
Christopher M. Rubino ◽  
Jeffrey P. Hammel ◽  
Alan Forrest ◽  
Nathalie Dartois ◽  
...  
Keyword(s):  
Clinical Success ◽  
Statistical Significance ◽  
Patient Specific ◽  
Specific Response ◽  
Multivariable Logistic Regression Model ◽  
Time Curve ◽  
Response Data ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired ◽  
The Impact

ABSTRACTPharmacokinetic and clinical data from tigecycline-treated patients with hospital-acquired pneumonia (HAP) who were enrolled in a phase 3 clinical trial were integrated in order to evaluate pharmacokinetic-pharmacodynamic (PK-PD) relationships for efficacy. Univariable and multivariable analyses were conducted to identify factors associated with clinical and microbiological responses, based on data from 61 evaluable HAP patients who received tigecycline intravenously as a 100-mg loading dose followed by 50 mg every 12 h for a minimum of 7 days and for whom there were adequate clinical, pharmacokinetic, and response data. The final multivariable logistic regression model for clinical response contained albumin and the ratio of the free-drug area under the concentration-time curve from 0 to 24 h (fAUC0–24) to the MIC (fAUC0–24:MIC ratio). The odds of clinical success were 13.0 times higher for every 1-g/dl increase in albumin (P< 0.001) and 8.42 times higher for patients withfAUC0–24:MIC ratios of ≥0.9 compared to patients withfAUC0–24:MIC ratios of <0.9 (P= 0.008). Average model-estimated probabilities of clinical success for the albumin/fAUC0–24:MIC ratio combinations of <2.6/<0.9, <2.6/≥0.9, ≥2.6/<0.9, and ≥2.6/≥0.9 were 0.21, 0.57, 0.64, and 0.93, respectively. For microbiological response, the final model contained albumin and ventilator-associated pneumonia (VAP) status. The odds of microbiological success were 21.0 times higher for every 1-g/dl increase in albumin (P< 0.001) and 8.59 times higher for patients without VAP compared to those with VAP (P= 0.003). Among the remaining variables evaluated, the MIC had the greatest statistical significance, an observation which was not surprising given the differences in MIC distributions between VAP and non-VAP patients (MIC50and MIC90values of 0.5 and 0.25 mg/liter versus 16 and 1 mg/liter for VAP versus non-VAP patients, respectively;P= 0.006). These findings demonstrated the impact of pharmacological and patient-specific factors on the clinical and microbiological responses.

Antimicrobial prescribing for hospital-acquired pneumonia

2020 ◽  
Vol 81 (1) ◽  
pp. 1-3
Author(s):  
Tim Felton ◽  
Dan Wootton
Keyword(s):  
Decision Making ◽  
Antibiotic Prescribing ◽  
High Quality ◽  
Antimicrobial Prescribing ◽  
High Quality Evidence ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired ◽  
The Impact ◽  
Inform Decision Making ◽  
Quality Evidence

The impact of hospital-acquired pneumonia and the pressure to reduce unnecessary antibiotic prescribing has lead to the publication of prescribing guidelines from the National Institute for Health and Care Excellence. This editorial gives an overview of the guidelines and emphasises the need for more high-quality evidence to inform decision making in this group of patients.

scholarly journals HSV-1 reactivation is associated with an increased risk of mortality and pneumonia in critically ill COVID-19 patients

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Antoine Meyer ◽  
Niccolò Buetti ◽  
Nadhira Houhou-Fidouh ◽  
Juliette Patrier ◽  
Moustafa Abdel-Nabey ◽  
...  
Keyword(s):  
Critically Ill ◽  
Mortality Risk ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Hospital Acquired Pneumonia ◽  
Simplex Virus ◽  
Healthcare Associated ◽  
Hospital Acquired ◽  
The Impact ◽  
Hsv 1

Abstract Background Data in the literature about HSV reactivation in COVID-19 patients are scarce, and the association between HSV-1 reactivation and mortality remains to be determined. Our objectives were to evaluate the impact of Herpes simplex virus (HSV) reactivation in patients with severe SARS-CoV-2 infections primarily on mortality, and secondarily on hospital-acquired pneumonia/ventilator-associated pneumonia (HAP/VAP) and intensive care unit-bloodstream infection (ICU-BSI). Methods We conducted an observational study using prospectively collected data and HSV-1 blood and respiratory samples from all critically ill COVID-19 patients in a large reference center who underwent HSV tests. Using multivariable Cox and cause-specific (cs) models, we investigated the association between HSV reactivation and mortality or healthcare-associated infections. Results Of the 153 COVID-19 patients admitted for ≥ 48 h from Feb-2020 to Feb-2021, 40/153 (26.1%) patients had confirmed HSV-1 reactivation (19/61 (31.1%) with HSV-positive respiratory samples, and 36/146 (24.7%) with HSV-positive blood samples. Day-60 mortality was higher in patients with HSV-1 reactivation (57.5%) versus without (33.6%, p = 0.001). After adjustment for mortality risk factors, HSV-1 reactivation was associated with an increased mortality risk (hazard risk [HR] 2.05; 95% CI 1.16–3.62; p = 0.01). HAP/VAP occurred in 67/153 (43.8%) and ICU-BSI in 42/153 (27.5%) patients. In patients with HSV-1 reactivation, multivariable cause-specific models showed an increased risk of HAP/VAP (csHR 2.38, 95% CI 1.06–5.39, p = 0.037), but not of ICU-BSI. Conclusions HSV-1 reactivation in critically ill COVID-19 patients was associated with an increased risk of day-60 mortality and HAP/VAP.

scholarly journals Quantifying Uncertainty and Robustness in a Biomathematical Model–Based Patient-Specific Response Metric for Glioblastoma

2019 ◽  
pp. 1-8 ◽  
Author(s):  
Andrea Hawkins-Daarud ◽  
Sandra K. Johnston ◽  
Kristin R. Swanson
Keyword(s):  
Synthetic Data ◽  
Magnetic Resonance Images ◽  
Patient Specific ◽  
Specific Response ◽  
Time To Progression ◽  
Interobserver Error ◽  
Standard Response ◽  
Clinical Variants ◽  
Tumor Kinetics ◽  
The Impact

Purpose Glioblastomas, lethal primary brain tumors, are known for their heterogeneity and invasiveness. A growing body of literature has been developed demonstrating the clinical relevance of a biomathematical model, the proliferation-invasion model, of glioblastoma growth. Of interest here is the development of a treatment response metric, days gained (DG). This metric is based on individual tumor kinetics estimated through segmented volumes of hyperintense regions on T1-weighted gadolinium-enhanced and T2-weighted magnetic resonance images. This metric was shown to be prognostic of time to progression. Furthermore, it was shown to be more prognostic of outcome than standard response metrics. Although promising, the original article did not account for uncertainty in the calculation of the DG metric, leaving the robustness of this cutoff in question. Methods We harnessed the Bayesian framework to consider the impact of two sources of uncertainty: (1) image acquisition and (2) interobserver error in image segmentation. We first used synthetic data to characterize what nonerror variants are influencing the final uncertainty in the DG metric. We then considered the original patient cohort to investigate clinical patterns of uncertainty and to determine how robust this metric is for predicting time to progression and overall survival. Results Our results indicate that the key clinical variants are the time between pretreatment images and the underlying tumor growth kinetics, matching our observations in the clinical cohort. Finally, we demonstrated that for this cohort, there was a continuous range of cutoffs between 94 and 105 for which the prediction of the time to progression was over 80% reliable. Conclusion Although additional validation must be performed, this work represents a key step in ascertaining the clinical utility of this metric.

scholarly journals Pilot Study: Evaluating the Impact of Pharmacist Patient-Specific Medication Recommendations for Diabetes Mellitus Therapy to Family Medicine Residents

Pharmacy ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 158
Author(s):  
Camlyn Masuda ◽  
Rachel Randall ◽  
Marina Ortiz
Keyword(s):  
Diabetes Mellitus ◽  
Pilot Study ◽  
Family Medicine ◽  
Statistical Significance ◽  
Diabetes Education ◽  
Office Visit ◽  
Patient Specific ◽  
Patients With Diabetes ◽  
The Impact ◽  
Family Medicine Residents

Pharmacists have demonstrated effectiveness in managing diabetes mellitus (DM) and lowering hemoglobin A1C (A1C) through direct patient management. Often patients with diabetes and elevated A1C may not be able to come into the clinic for separate appointments with a pharmacist or for diabetes education classes. A novel way that pharmacists can assist in improving the control of patients’ diabetes and improve prescriber understanding and the use of medications for diabetes is by providing medication recommendations to medical residents prior to the patient’s appointment with the medical resident. The results of this pilot study indicate that the recommendations provided to family medicine residents and implemented at the patient’s office visit helped to lower A1C levels, although the population size was too small to show statistical significance. This pilot study’s results support performing a larger study to determine if the pharmacist’s recommendation not only improves patient care by lowering A1C levels but if it also helps improve medical resident’s understanding and use of medications for diabetes.

The impact of a bundle to prevent hospital-acquired pneumonia in a cohort of nonventilated patients on enteral nutrition

2020 ◽  
Vol 42 (1) ◽  
pp. 100-102
Author(s):  
Michelli Cristina Silva de Assis ◽  
Andreia Barcellos Teixeira Macedo ◽  
Célia Mariana Barbosa de Souza Martins ◽  
Loriane Rita Konkewicz ◽  
Luciana Verçoza Viana ◽  
...  
Keyword(s):  
Experimental Study ◽  
Enteral Nutrition ◽  
Tube Feeding ◽  
Enteral Tube Feeding ◽  
Quasi Experimental ◽  
Hospital Acquired Pneumonia ◽  
Bundle Compliance ◽  
Hospital Acquired ◽  
The Impact

AbstractWe conducted a quasi-experimental study to evaluate a bundle to prevent nonventilator hospital-acquired pneumonia (NV-HAP) in patients on enteral tube feeding. After the intervention, there was an increase in bundle compliance from 55.9% to 70.5% (P < .01) and a significant decrease (34%) in overall NV-HAP rates from 5.71 to 3.77 of 1,000 admissions.

scholarly journals 64 The Impact of Inadequate Pain Control Following Chest Trauma on The Incidence of Hospital Acquired Pneumonia and Hospital Admission Length

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
W Butterworth ◽  
O T Ong ◽  
O Magar ◽  
J Bird ◽  
R Scannell
Keyword(s):  
Patient Outcomes ◽  
Pain Control ◽  
Major Trauma ◽  
Chest Trauma ◽  
Trauma Patients ◽  
Permanent Disability ◽  
Retrospective Audit ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired ◽  
The Impact

Abstract Introduction The National Audit Office (2010) report estimated there was 20,000 cases of major trauma per year in England; of which 5,400 died and many others sustaining permanent disability. Blunt chest wall injuries are associated with high levels of morbidity and mortality, and we aimed to investigate the impact of poor pain control in patient outcomes. Method Compliance with trust guidelines was assessed via a retrospective audit of all chest trauma patients between October 2019-20. Results 28 chest trauma patients identified (M:F 15:13) with ages ranging from 47-94 yrs old (average age 73). Chest trauma was associated with high levels of morbidity (32%) and mortality (7%). 39% patients were found to have inadequate pain control. Only 17% patients eligible for regional anaesthetic blocks were performed within 24hrs. 33% patients developed hospital acquired pneumonias (HAP), of which 44% had received inadequate pain control. Average admission length of patients with a HAP was 15 days compared to 5 days without. 85% patients experienced either delayed or no assessment by specialist teams (i.e., physiotherapy, pain team). Conclusions Chest trauma patients often receive inadequate pain control and delayed specialist team input resulting in increased frequency of HAPs, admission length and morbidity/mortality.

Risk of Stroke-Associated Pneumonia and Oral Hygiene

2015 ◽  
Vol 41 (1-2) ◽  
pp. 35-39 ◽  
Author(s):  
Cynthia Wagner ◽  
Sarah Marchina ◽  
Judith A. Deveau ◽  
Colleen Frayne ◽  
Kim Sulmonte ◽  
...  
Keyword(s):  
Oral Hygiene ◽  
Pathogenic Bacteria ◽  
Academic Medical Center ◽  
Intervention Group ◽  
Control Group ◽  
Stroke Patients ◽  
Effective Prevention ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired ◽  
The Impact

Background: Pneumonia is a major complication of stroke, but effective prevention strategies are lacking. Since aspiration of oropharyngeal secretions is the primary mechanism for development of stroke-associated pneumonia, strategies that decrease oral colonization with pathogenic bacteria may help curtail pneumonia risk. We therefore hypothesized that systematic oral care protocols can help decrease pneumonia risk in hospitalized stroke patients. In this study, we investigated the impact of a systematic oral hygiene care (OHC) program in reducing hospital-acquired pneumonia in patients with acute-subacute stroke. Methods: This study compared the proportion of pneumonia cases in hospitalized stroke patients before and after implementation of a systematic OHC intervention. All patients hospitalized with acute ischemic stroke or intracerebral hemorrhage admitted to a large, urban academic medical center in Boston, Mass., USA from May 31, 2008, to June 1, 2010 (epoch prior to implementation of OHC), and from January 1, 2012, to December 31, 2013 (epoch after full implementation of OHC), who were 18 years of age and hospitalized for ≥2 days were eligible for inclusion. The cohort in the first epoch constituted the control group whereas the cohort in the second epoch formed the intervention group. Multivariate logistic regression was used to control for confounders. The main outcome measure was hospital-acquired pneumonia, defined via International Classification of Diseases, Ninth Revision, Clinical Modification codes. Results: The cohort comprised 1,656 admissions (707 formed historical controls; 949 were in the intervention group). The unadjusted incidence of hospital-acquired pneumonia was lower in the group assigned to OHC compared to controls (14 vs. 10.33%; p = 0.022) with an unadjusted OR of 0.68 (95% CI 0.48-0.95; p = 0.022). After adjustment for influential confounders, the OR of hospital-acquired pneumonia in the intervention group remained significantly lower at 0.71 (95% CI 0.51-0.98; p = 0.041). Conclusion: In this large hospital-based cohort of patients admitted with acute stroke, systematic OHC use was associated with decreased odds of hospital-acquired pneumonia.

Influence of microbiological culture results on antibiotic choices for veterans with hospital-acquired pneumonia and ventilator-associated pneumonia

2021 ◽  
pp. 1-8
Author(s):  
Taissa A. Bej ◽  
Robbie L. Christian ◽  
Sharanie V. Sims ◽  
Brigid M. Wilson ◽  
Sunah Song ◽  
...  
Keyword(s):  
Positive Culture ◽  
Ventilator Associated Pneumonia ◽  
Veterans Health ◽  
Health Administration ◽  
Sample Collection ◽  
Negative Results ◽  
Small Influence ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired ◽  
The Impact

Abstract Objective: We examined the impact of microbiological results from respiratory samples on choice of antibiotic therapy in patients treated for hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP). Design: Four-year retrospective study. Setting: Veterans’ Health Administration (VHA). Patients: VHA patients hospitalized with HAP or VAP and with respiratory cultures between October 1, 2014, and September 30, 2018. Interventions: We compared patients with positive and negative respiratory culture results, assessing changes in antibiotic class and Antibiotic Spectrum Index (ASI) from the day of sample collection (day 0) through day 7. Results: Between October 1, 2014, and September 30, 2018, we identified 5,086 patients with HAP/VAP: 2,952 with positive culture results and 2,134 with negative culture results. All-cause 30-day mortality was 21% for both groups. The mean time from respiratory sample receipt in the laboratory to final respiratory culture result was longer for those with positive (2.9 ± 1.3 days) compared to negative results (2.5 ± 1.3 days; P < .001). The most common pathogens were Staphylococcus aureus and Pseudomonas aeruginosa. Vancomycin and β-lactam/β-lactamase inhibitors were the most commonly prescribed agents. The decrease in the median ASI from 13 to 8 between days 0 and 6 was similar among patients with positive and negative respiratory cultures. Patients with negative cultures were more likely to be off antibiotics from day 3 onward. Conclusions: The results of respiratory cultures had only a small influence on antibiotics used during the treatment of HAP/VAP. The decrease in ASI for both groups suggests the integration of antibiotic stewardship principles, including de-escalation, into the care of patients with HAP/VAP.

scholarly journals Quantifying Uncertainty and Robustness in a Biomathematical Model Based Patient-Specific Response Metric for Glioblastoma

2018 ◽  
Author(s):  
Andrea Hawkins-Daarud ◽  
Sandra K. Johnston ◽  
Kristin R. Swanson
Keyword(s):  
Synthetic Data ◽  
Magnetic Resonance Images ◽  
Patient Specific ◽  
Specific Response ◽  
Time To Progression ◽  
Interobserver Error ◽  
Standard Response ◽  
Pre Treatment ◽  
Tumor Kinetics ◽  
The Impact

AbstractGlioblastomas, lethal primary brain tumors, are known for their heterogeneity and invasiveness. A growing literature has been developed demonstrating the clinical relevance of a biomathematical model, the Proliferation-Invasion (PI) model, of glioblastoma growth. Of interest here is the development of a treatment response metric, Days Gained (DG). This metric is based on individual tumor kinetics estimated through segmented volumes of hyperintense regions on T1-weighted gadolinium enhanced (T1Gd) and T2-weighted magnetic resonance images (MRIs). This metric was shown to be prognostic of time to progression. Further, it was shown to be more prognostic of outcome than standard response metrics. While promising, the original paper did not account for uncertainty in the calculation of the DG metric leaving the robustness of this cutoff in question. We harness the Bayesian framework to consider the impact of two sources of uncertainty: 1) image acquisition and 2) interobserver error in image segmentation. We first utilize synthetic data to characterize what non-error variants are influencing the final uncertainty in the DG metric. We then consider the original patient cohort to investigate clinical patterns of uncertainty and to determine how robust this metric is for predicting time to progression and overall survival. Our results indicate that the key clinical variants are the time between pre-treatment images and the underlying tumor growth kinetics, matching our observations in the clinical cohort. Finally, we demonstrated that for this cohort there was a continuous range of cutoffs between 94 and 105 for which the prediction of the time to progression and was over 80% reliable. While further validation must be done, this work represents a key step in ascertaining the clinical utility of this metric.

scholarly journals 1023 An Audit of The Prevalence of Frailty and The Impact on Surgical Management and Resource Use, For Vascular Inpatients Using the National Vascular Registry (NVR) Frailty Classifications

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
L Hitchman ◽  
J Palmer ◽  
S Sethi ◽  
I Chetter
Keyword(s):  
Primary Outcome ◽  
Kidney Injury ◽  
Electronic Patient Records ◽  
Mortality And Morbidity ◽  
Frailty Status ◽  
Frailty Assessment ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired ◽  
The Impact ◽  
Frailty Score

Abstract Aim To determine if the NVR frailty score was being routinely collected on all relevant vascular patients on admission, identify the prevalence of frailty in vascular inpatients and determine if frailty was associated with a higher mortality and morbidity. Method A prospective audit of consecutive patients admitted onto the vascular ward who were eligible for inclusion on the NVR. Data was collected from electronic patient records and paper case notes between November 2019 and February 2020. The primary outcome was completeness of frailty assessment. Secondary outcomes were prevalence of frailty and mortality and morbidity associated with frailty score. Results Frailty status was documented in 65% of patients. 43% (28/65) were assessed to be frail. The 30-day mortality rate was 1.53% (1/65). 26.15% (17/65) had one or more complication. The commonest complications were graft occlusions, acute kidney injury, hospital acquired pneumonia and groin infections. 93.84% (61/65) were discharged home. There was no correlation between frailty and number of post-operative complications (p = 0.394), length of stay (p = 0.171) or mortality (p = 0.371). Conclusions This audit found frailty assessment is poorly assessed and the current NVR frailty classification did not correlate to increase mortality or morbidity in this patient cohort.

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