Real-World Effects of Antibiotic Treatment on Acute COPD Exacerbations in Outpatients: A Cohort Study under the PharmLines Initiative

Background: Although antibiotic treatment is recommended for acute exacerbations of chronic obstructive pulmonary disease (AECOPD), its value in real-world settings is still controversial. Objectives: This study aimed to evaluate the short- and long-term effects of antibiotic treatment on AECOPD outpatients. Methods: A cohort study was conducted under the PharmLines Initiative. We included participants with a first recorded diagnosis of COPD who received systemic glucocorticoid treatment for an AECOPD episode. The exposed and reference groups were defined based on any antibiotic prescription during the AECOPD treatment. The short-term outcome was AECOPD treatment failure within 14–30 days after the index date. The long-term outcome was time to the next exacerbation. Adjustment for confounding was made using propensity scores. Results: Of the 1,105 AECOPD patients, antibiotics were prescribed to 518 patients (46.9%) while 587 patients (53.1%) received no antibiotics. The overall antibiotic use was associated with a relative risk reduction of AECOPD treatment failure by 37% compared with the reference group (adjusted odds ratio [aOR] 0.63 [95% CI: 0.40–0.99]). Protective effects were similar for doxycycline, macrolides, and co-amoxiclav, although only the effect of doxycycline was statistically significant (aOR 0.53 [95% CI: 0.28–0.99]). No protective effect was seen for amoxicillin (aOR 1.49 [95% CI: 0.78–2.84]). The risk of and time to the next exacerbation was similar for both groups. Conclusion: Overall, antibiotic treatment, notably with doxycycline, supplementing systemic glucocorticoids reduces short-term AECOPD treatment failure in real-world outpatient settings. No long-term beneficial effects of antibiotic treatment on AECOPD were found for the prevention of subsequent exacerbations.

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Biomarkers to enhance accuracy and precision of prediction of short-term and long-term outcome after spontaneous intracerebral haemorrhage: a study protocol for a prospective cohort study

BMC Neurology ◽

10.1186/s12883-015-0384-3 ◽

2015 ◽

Vol 15 (1) ◽

Cited By ~ 7

Author(s):

A. Kumar ◽

P. Kumar ◽

S. Misra ◽

R. Sagar ◽

P. Kathuria ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Intracerebral Haemorrhage ◽

Prospective Cohort ◽

Short Term ◽

Term Outcome ◽

Long Term Outcome ◽

Accuracy And Precision ◽

Spontaneous Intracerebral Haemorrhage

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

World Journal of Surgery ◽

10.1007/s00268-013-2311-3 ◽

2013 ◽

Vol 38 (2) ◽

pp. 347-354 ◽

Cited By ~ 13

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

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Comprehensive Evaluation of Time-to-Response Parameter as a Predictor of Long-Term Outcomes Following Imatinib Therapy in Chronic Phase Chronic Myeloid Leukemia.

Blood ◽

10.1182/blood.v114.22.1110.1110 ◽

2009 ◽

Vol 114 (22) ◽

pp. 1110-1110

Author(s):

Dong Hwan (Dennis) Kim ◽

Jung A. Kim ◽

Jina Yun ◽

Lakshmi Sriharsha ◽

Jun Ho Jang ◽

...

Keyword(s):

Treatment Failure ◽

Chronic Phase ◽

Cytogenetic Response ◽

Imatinib Therapy ◽

Long Term Outcomes ◽

Short Term ◽

Term Outcome ◽

Long Term Outcome ◽

Log Reduction

Abstract Abstract 1110 Poster Board I-132 Introduction Early recognition of high-risk patients is important when planning further therapeutic intervention for imatinib treatment failure in patients with chronic myeloid leukemia (CML). Current guideline such as European Leukemia Network (ELN) emphasizes 3, 6, 12, and 18 months cutoff as decision point of imatinib therapy for CML. However, direct evidence of ELN guideline is still lacking. In addition, some controversy surrounds the questions: 1) which of the short-term response parameters (major cytogenetic response [MCyR], complete cytogenetic response [CCyR], or major molecular response [MMR]) is the best surrogate for long-term outcomes, 2) which time point (6, 12 or 18 months) reflect the best correlation with long-term outcomes and 3) if we exclusively use BCR/ABL quantitative PCR to monitor the response, what value for BCR/ABL levels is the best predictor for long-term outcomes. Methods In this comprehensive analysis, we adopted the landmark analysis method, time-dependent Cox's proportional hazard model and receiver-operating characteristics (ROC) method to analyze time-to-response parameter as predictor of long-term outcomes in 187 chronic phase (CP) CML patients receiving imatinib at least for one year at the Princess Margaret Hospital (Toronto, Canada). Results Regardless of the method of analysis, we found that the earlier achievement of short-term response such as CCyR or MMR could predict the higher probability of achieving better interim outcome (such as treatment failure or loss of response), but not a long-term outcome (such as overall survival). Similar to the finding from other studies, our ROC analysis provided cutoff time range for MMR (18-36 months) and CCyR (6-12 months) that were the best predictors for CMR, LOR or treatment failure. Accordingly, the cutoffs of 12 months of CCyR or 18 months of MMR in the ELN guideline for the definition of suboptimal response could be justified based on the current result. In addition, BCR/ABL transcripts of 1.5-2.0 log reduction at 6 months and 2.0-2.5 log reduction at 12 months were better predictors of long-term outcomes following imatinib therapy in CP CML patients than the achievement of CCyR or MMR at 12 months. Conclusion The results of the current study confirm that regardless of the analytic method used (landmark analysis or time-dependent Cox's analysis), the time-to-response short-term parameter could predict the interim subsequent outcome (i.e., loss of response), but not a long-term outcome (i.e. overall survival). The ROC analysis method could provide the answer of when CML patients will be evaluated for appropriate response following imatinib therapy (i.e. MMR at 18-36 months and CCyR at 6-12 months). The current data can be a supporting evidence of ELN criteria definition of suboptimal response. In addition, the present study also suggested that the BCR/ABL transcript levels at 6 or 12 months could be an alternative early predictor of long-term outcomes. Disclosures No relevant conflicts of interest to declare.

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Long-Term Outcome of Pyogenic Vertebral Osteomyelitis: A Cohort Study of 260 Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofu107 ◽

2014 ◽

Vol 1 (3) ◽

Cited By ~ 31

Author(s):

Arjun Gupta ◽

Todd J. Kowalski ◽

Douglas R. Osmon ◽

Mark Enzler ◽

James M. Steckelberg ◽

...

Keyword(s):

Cohort Study ◽

Back Pain ◽

Treatment Failure ◽

Vertebral Osteomyelitis ◽

Term Outcome ◽

Duration Of Symptoms ◽

Long Term Outcome ◽

Increased Risk ◽

Pyogenic Vertebral Osteomyelitis

Abstract Background. The long-term outcome of patients with pyogenic vertebral osteomyelitis (PVO) has not been fully assessed. Methods. We conducted a retrospective cohort study to describe the long-term outcome of PVO and to assess risk factors for treatment failure in patients evaluated at our institution between 1994 and 2002. Patients were observed until July 1, 2013. Results. Two hundred sixty patients with PVO were included in this study. Twenty-seven percent (70) of patients developed their infection after an invasive spinal procedure. Staphylococcus aureus accounted for 40% (103) of infections. Forty-nine percent (128) of patients underwent spinal surgery as part of their initial therapy. The median duration of parenteral antimicrobial therapy was 42 days (interquartile range, 38–53). The estimated 2-, 5-, and 10-year cumulative probability of treatment failure-free survival was 72%, 69%, and 69%, respectively. Seventy-five percent of patients who developed treatment failure did so within 4.7 months of diagnosis. Residual neurological defects and persistent back pain were seen in 16% and 32% of patients, respectively. In a multivariate analysis, longer duration of symptoms before diagnosis and having an infection with S. aureus were associated with increased risk of treatment failure. Conclusions. Increasing duration of symptoms and infection with S. aureus were associated with treatment failure in patients with PVO. Most treatment failures occurred early after initiation of treatment. Pyogenic vertebral osteomyelitis is associated with a high 2-year failure rate. Persistent neurological deficits and back pain are common after therapy.

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