scholarly journals Increasing use of linezolid in a tertiary NICU during a 10-year period: reasons and concerns for the future

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Lucie Matrat ◽  
Frank Plaisant ◽  
Christine Barreto ◽  
Olivier Claris ◽  
Marine Butin
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort ◽  
Bacterial Resistance ◽  
Antibiotic Use ◽  
Line Treatment ◽  
First Line ◽  
Coagulase Negative Staphylococci ◽  
Persistent Bacteremia ◽  
Therapeutic Alternatives ◽  
First Line Treatment

Abstract Background Linezolid has been increasingly used in tertiary NICUs. The objectives of this study were to explore the indications of these linezolid prescriptions, to analyze a possible misuse and to provide solutions to avoid such misuse. Methods A monocentric retrospective cohort study included all neonates hospitalized in one tertiary NICU between January 1st, 2010 and December 31st, 2019 and who received at least one administration of linezolid. These data were confronted to epidemiological and antibiotic use data from the same NICU. Two independent pediatricians secondarily classified linezolid uses as adequate or not. Results During the study period, 66 infections in 57 patients led to linezolid use. Most patients were pre-term and 21 patients (37%) died. Infections were mainly related to methicillin-resistant coagulase negative staphylococci and were frequently either pneumoniae (35%) or isolated bacteremia (48%), including 25 persistent bacteremia (64% of the 39 bacteremia). Need for a better tissue distribution or first-line treatment failure were the main reasons to initiate linezolid. Linezolid was administered for a median duration of 7 [3;10] days. No side effects were reported. Twenty-two (33%) of the 66 linezolid prescriptions were retrospectively classified as inadequate. Conclusions A rapid increase in linezolid prescriptions has been observed in our tertiary NICU, from 2014 to 2019, with 33% inadequate uses. This worrisome trend should lead to search for therapeutic alternatives and to work on antibiotic stewardship to prevent the emergence of new antimicrobial bacterial resistance.

scholarly journals Increasing use of linezolid in a tertiary NICU during a 10-year period: reasons and concerns for the future

2020 ◽  
Author(s):  
Lucie Matrat ◽  
Frank Plaisant ◽  
Christine Barreto ◽  
Olivier Claris ◽  
Marine Butin
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort ◽  
Bacterial Resistance ◽  
Antibiotic Use ◽  
Line Treatment ◽  
First Line ◽  
Coagulase Negative Staphylococci ◽  
Persistent Bacteremia ◽  
Therapeutic Alternatives ◽  
First Line Treatment

Abstract Background Linezolid has been increasingly used in tertiary NICUs. The objectives of this study were to explore the indications of these linezolid prescriptions, to analyze a possible misuse and to provide solutions to avoid such misuse. Methods A monocentric retrospective cohort study included all neonates hospitalized in one tertiary NICU between January 1st, 2010 and December 31st, 2019 and who received at least one administration of linezolid. These data were confronted to epidemiological and antibiotic use data from the same NICU. Two independent pediatricians secondarily classified linezolid uses as adequate or not. Results During the study period, 66 infections in 57 patients led to linezolid use. Most patients were pre-term and 21 patients (37%) died. Infections were mainly related to methicillin-resistant coagulase negative staphylococci and were frequently either pneumoniae (35%) or isolated bacteremia (48%), including 25 persistent bacteremia (64% of the 39 bacteremia). Need for a better tissue distribution or first-line treatment failure were the main reasons to initiate linezolid. Linezolid was administered for a median duration of 7 [3;10] days. No side effects were reported. Twenty-two (33%) of the 66 linezolid prescriptions were retrospectively classified as inadequate. Conclusions A rapid increase in linezolid prescriptions has been observed in our tertiary NICU, from 2014 to 2019, with 33% inadequate uses. This worrisome trend should lead to search for therapeutic alternatives and to work on antibiotic stewardship to prevent the emergence of new antimicrobial bacterial resistance.

scholarly journals Increasing use of linezolid in a tertiary NICU during a 10-year period: reasons and concerns for the future

2020 ◽  
Author(s):  
Lucie Matrat ◽  
Frank Plaisant ◽  
Christine Barreto ◽  
Olivier Claris ◽  
Marine Butin
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort ◽  
Bacterial Resistance ◽  
Antibiotic Use ◽  
Line Treatment ◽  
First Line ◽  
Coagulase Negative Staphylococci ◽  
Persistent Bacteremia ◽  
Therapeutic Alternatives ◽  
First Line Treatment

Abstract Background: Linezolid has been increasingly used in tertiary NICUs. The objectives of this study were to explore the indications of these linezolid prescriptions, to analyze a possible misuse and to provide solutions to avoid such misuse.Methods: A monocentric retrospective cohort study included all neonates hospitalized in one tertiary NICU between January 1st, 2010 and December 31st, 2019 and who received at least one administration of linezolid. These data were confronted to epidemiological and antibiotic use data from the same NICU. Two independent pediatricians secondarily classified linezolid uses as adequate or not.Results: During the study period, 66 infections in 57 patients led to linezolid use. Most patients were pre-term and 21 patients (37%) died. Infections were mainly related to methicillin-resistant coagulase negative staphylococci and were frequently either pneumoniae (35%) or isolated bacteremia (48%), including 25 persistent bacteremia (64% of the 39 bacteremia). Need for a better tissue distribution or first-line treatment failure were the main reasons to initiate linezolid. Linezolid was administered for a median duration of 7 [3;10] days. No side effects were reported. Twenty-two (33%) of the 66 linezolid prescriptions were retrospectively classified as inadequate. Conclusions: A rapid increase in linezolid prescriptions has been observed in our tertiary NICU, from 2014 to 2019, with 33% inadequate uses. This worrisome trend should lead to search for therapeutic alternatives and to work on antibiotic stewardship to prevent the emergence of new antimicrobial bacterial resistance.

scholarly journals Glucocorticoids Are Preferable to Thionamides as First-Line Treatment for Amiodarone-Induced Thyrotoxicosis due to Destructive Thyroiditis: A Matched Retrospective Cohort Study

2009 ◽  
Vol 94 (10) ◽  
pp. 3757-3762 ◽  
Author(s):  
Fausto Bogazzi ◽  
Luca Tomisti ◽  
Giuseppe Rossi ◽  
Enrica Dell'Unto ◽  
Pasquale Pepe ◽  
...  
Keyword(s):  
Cohort Study ◽  
Confidence Interval ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Line Treatment ◽  
First Line ◽  
University Center ◽  
Cure Time ◽  
First Line Treatment

Context: Type 2 amiodarone-induced thyrotoxicosis (AIT) is a destructive thyroiditis usually responsive to glucocorticoids; however, recent surveys showed that many expert thyroidologists worldwide use thionamides for type 2 AIT patients. Objective: The objective of the study was to compare the effectiveness of methimazole (MMI) or prednisone (GLU) in type 2 AIT patients who had a short cure time according to a published predictive model. Design: This was a matched retrospective cohort study. Setting: The study was conducted at a university center. Patients: Forty-two untreated type 2 AIT patients with a predicted cure time ≤40 d were divided into two groups (MMI and GLU groups). After matching for the predicted cure time, patients in the GLU group were selected in a 1:1 ratio to patients in the MMI group. Intervention: Patients were treated with GLU or MMI for 40 d. Patients still thyrotoxic after 40 d continued glucocorticoids if in the GLU group or were switched to prednisone (MMI-GLU group) if in the MMI group. Main Outcome Measure: Time and rate of cure (healing) at 40 d were measured. Results: Patients still thyrotoxic after 40 d were 23.8 ± 9.3% in the GLU group and 85.7 ± 7.6% in the MMI group (P = 0.000). The GLU and MMI-GLU groups did not significantly differ in the nonhealing rate at 40 d (P = 0.730). When patients in the MMI group were treated with glucocorticoids, 94.1% patients achieved euthyroidism within 40 d. However, the global median cure time (MMI period + prednisone period) was longer (60 d, 95% confidence interval 53.5–66.5 d) in the MMI-GLU group than the GLU group (21 d, 95% confidence interval 15.1–26.9 d). Conclusions: Glucocorticoids are the first-line treatment in type 2 AIT, whereas thionamides play no role in this destructive thyroiditis. Glucocorticoids are the first-line treatment in type 2 amiodarone-induced thyrotoxicosis while thionamides play no role in this destructive thyroiditis.

Antibiotics in treatment of peritonsillar infection: clindamycin versus penicillin

2021 ◽  
Vol 135 (1) ◽  
pp. 64-69
Author(s):  
F Hallgren ◽  
E Lindell ◽  
B Nilsson-Helger ◽  
A Lundqvist
Keyword(s):  
Antibiotic Resistance ◽  
Cohort Study ◽  
Adverse Effects ◽  
Retrospective Cohort ◽  
Peritonsillar Abscess ◽  
Collateral Damage ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

AbstractObjectiveThis study aimed to compare antibiotic treatment with clindamycin versus penicillin V or G in terms of time to recovery and recurrence in patients with peritonsillar infection, including both peritonsillar cellulitis and peritonsillar abscess.MethodThis retrospective cohort study examined the records of 296 patients diagnosed with peritonsillar infection. Based on the ENT doctor's choice of antibiotics, patients were divided into clindamycin and penicillin groups.ResultsMean number of days in follow up was 3.5 days in the clindamycin group and 3.4 days in the penicillin group. The recurrence rate within 2 months was 7 per cent in the clindamycin group and 4 per cent in the penicillin group.ConclusionThis study found no significant differences in either recovery or recurrence between the groups. This supports the use of penicillin as a first-line treatment, considering the greater frequency of adverse effects of clindamycin shown in previous studies, as well as its profound collateral damage on the intestinal microbiota, resulting in antibiotic resistance.

scholarly journals Bortezomib-based therapy in non-transplant multiple myeloma patients: a retrospective cohort study from the FABIO project

2021 ◽  
Vol 12 ◽  
pp. 204062072199648
Author(s):  
Matteo Franchi ◽  
Claudia Vener ◽  
Donatella Garau ◽  
Ursula Kirchmayer ◽  
Mirko Di Martino ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Cohort Study ◽  
Cost Effectiveness ◽  
Line Treatment ◽  
First Line ◽  
Conventional Chemotherapy ◽  
Risk Of Death ◽  
Model Average ◽  
Italian Regions ◽  
First Line Treatment

Introduction: Randomized clinical trials showed that bortezomib, in addition to conventional chemotherapy, improves survival and disease progression in multiple myeloma (MM) patients not eligible for stem cell transplantation. The aim of this retrospective population-based cohort study is the evaluation of both clinical and economic profile of bortezomib-based versus conventional chemotherapy in daily clinical practice. Methods: Healthcare utilization databases of six Italian regions were used to identify adult patients with non-transplant MM, who started a first-line therapy with bortezomib-based or conventional chemotherapy. Patients were matched by propensity score and were followed from treatment start until death, lost to follow-up or study end-point. Overall survival (OS) and restricted mean survival time (RMST) were estimated using the Kaplan–Meier method. Association between first-line treatment and risk of death was estimated by a conditional Cox proportional regression model. Average mean cumulative costs were estimated and compared between groups. Results: In the period 2010–2016, 3509 non-transplant MM patients met the inclusion criteria, of which 1157 treated with bortezomib-based therapy were matched to 1826 treated with conventional chemotherapy. Median OS and RMST were 33.9 and 27.9 months, and 42.9 and 38.4 months, respectively, in the two treatment arms. Overall, these values corresponded to a HR of death of 0.79 (95% CI 0.71–0.89) over a time horizon of 84 months. Average cumulative cost were 83,839 € and 54,499 €, respectively, corresponding to an incremental cost-effectiveness ratio of 54,333 € per year of life gained, a cost coherent with the willingness-to-pay thresholds frequently adopted from Western countries. Conclusions: These data suggested that, in a large cohort of non-transplant MM patients treated outside the experimental setting, first-line treatment with bortezomib-based therapy was associated with a favourable effectiveness and cost-effectiveness profile.

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