scholarly journals A retrospective review on antibiotic use in acute watery diarrhea in children in a tertiary care hospital of Karachi, Pakistan

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0253712
Author(s):  
Sonia Qureshi ◽  
Shahzadi Resham ◽  
Mariam Hashmi ◽  
Abdullah B. Naveed ◽  
Zoya Haq ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Hospital Stay ◽  
Retrospective Review ◽  
Length Of Hospital Stay ◽  
Antibiotic Use ◽  
Watery Diarrhea ◽  
Care Hospital ◽  
Acute Watery Diarrhea ◽  
Prolonged Hospital ◽  
The Impact

Introduction Responsible for at least one in nine pediatric deaths, diarrheal diseases are the leading, global cause of death. Further abetted by improper antibiotic use in a hospital setting, children with acute watery diarrhea can see prolonged hospital stays, and unwanted adverse effects such as antibiotic resistance. Hence, this study is aimed to identify the association between antibiotic usage for the treatment of acute watery diarrhea in children, and the impact this line of management has on the duration of their hospital stay. Methods A retrospective review was conducted at the department of Pediatric of Aga Khan University Hospital (AKUH) in Karachi. A total of 305 records of children aged 6 months to 5 years who were admitted with a diagnosis of acute watery diarrhea from June 2017 –December 2018 was screened, of which 175 fulfilled the eligibility criteria. A predesigned questionnaire was used to collect demographic information, comorbidities, and clinical features, severity of dehydration, clinical examination, treatment received, and laboratory investigations. The primary outcome of this study was the length of hospital stay measured against the number of hours a child stayed in hospital for treatment of acute watery diarrhea. The statistical analysis was carried out using STATA version 14 to reach conclusive results. Results 175 patients presented with acute watery diarrhea, out of which 106 (60.6%) did not receive antibiotics. The median (IQR) age of the group that did not receive antibiotics was 12.0 (12.0) months compared to 15.0 (12.0) months for the group that did receive antibiotics. In both groups, there were more males than females, less than 15% of the patients were severely malnourished (WHZ score -3SD) and less than 10% of the patients were severely dehydrated. The median (IQR) length of hospital stay (hours) was 32.0 (19.0) respectively for the group that did not receive antibiotic and 41.0 (32.0) for the group that did receive antibiotic therapy. The expected length of hospital stay for the group that received antibiotic therapy was 0.22 hours higher than the group that did not. Finally, as compared to females, hospital stay for males was longer by 0.25 hours. Conclusion In conclusion, antibiotic use was associated with a prolonged hospital stay in children with acute watery diarrhea as compared to children who did not receive antibiotics. Large scale robust prospective studies are needed to establish this association using this observational data.

scholarly journals Staphylococcus Aureus: Selective Reporting of Antibiogram Results and Its Impact on Antibiotic Use. Interventional Study with a Reference Group on the Effect of Switching from Non-Selective to Selective Antibiotic Reporting

2020 ◽  
Author(s):  
Franka Lestin-Bernstein ◽  
Ramona Harberg ◽  
Ingo Schumacher ◽  
Lutz Briedigkeit ◽  
Oliver Heese ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Antibiotic Therapy ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Selective Reporting ◽  
Care Hospital ◽  
Beta Lactams ◽  
Interventional Study ◽  
Narrow Spectrum ◽  
The Impact

Abstract Background:Antimicrobial stewardship (AMS) strategies worldwide focus on optimised antibiotic use. Selective susceptibility reporting is recommended as an effective AMS tool, although there is a lack of representative studies investigating the impact of selective susceptibility reporting on antibiotic use.The aim of this study was to investigate the impact of selective susceptibility reporting of Staphylococcus aureus (S. aureus) on antibiotic consumption. Enhancing the use of narrow-spectrum beta-lactam antibiotics such as flucloxacillin/cefazolin/cefalexin is one of the main goals in optimising antibiotic therapy of S. aureus infections.Methods:This interventional study with control group was conducted at a tertiary care hospital in Germany. During the one-year interventional period, susceptibility reports for all methicillin-sensitive S. aureus (MSSA) were restricted to flucloxacillin/cefazolin/oral cefalexin, trimethoprim-sulfamethoxazole, clindamycin, gentamicin and rifampin/fosfomycin; instead of reporting all tested antibiotics during the year before the intervention and in the reference clinic. The impact of the intervention was analysed by monitoring antibiotic consumption (recommended daily dose/100 occupied bed days: RDD/100 BD).Results:MSSA-antibiograms were reported for 2836 patients. Total use of narrow-spectrum beta-lactams more than doubled during the intervention (from 1.2 to 2.8 RDD/100 BD, P<0.001; P<0.001 compared to the reference clinic); the percentage of total antibiotic use increased from 2.6% to 6.2%. A slight, but significant increase in the use of trimethoprim-sulfamethoxazole was also observed (+ 0.37 RDD/100 BD).There was no decrease in antibiotics withdrawn from the antibiogram, probably as a consequence of their wide use for indications other than S. aureus infections.Conclusions:As narrow-spectrum beta-lactams are not widely used for other infections, there is a strong indication that selective reporting guided clinicians to optimised antibiotic therapy of S. aureus infections.As useful AMS tool, we recommend implementing selective reporting rules into the national/international standards for susceptibility reporting.

scholarly journals The impact of complications on prolonged length of hospital stay after resection in colorectal cancer: A retrospective study of Taiwanese patients

2017 ◽  
Vol 45 (2) ◽  
pp. 691-705 ◽  
Author(s):  
Herng-Chia Chiu ◽  
Yi-Chieh Lin ◽  
Hui-Min Hsieh ◽  
Hsin-Pao Chen ◽  
Hui-Li Wang ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Prolonged Hospital Stay ◽  
Prolonged Length ◽  
Regression Methods ◽  
Major Complications ◽  
Prolonged Hospital ◽  
The Impact

Objectives To assess the impact of minor, major and individual complications on prolonged length of hospital stay in patients with colorectal cancer (CRC) after surgery using multivariate models. Methods This was a retrospective review of data from patients who underwent surgery for stage I–III CRC at two medical centres in southern Taiwan between 2005–2010. Information was derived from four databases. Multivariate logistic regression methods were used to assess the impact of complications on prolonged length of stay (PLOS) and prolonged postoperative length of stay (PPOLOS). Results Of 1658 study patients, 251 (15.1%) experienced minor or major postsurgical complications during hospitalizations. Minor and major complications were significantly associated with PLOS (minor, odds ratio [OR] 3.59; major, OR 8.82) and with PPOLOS (minor, OR 5.55; major, OR 10.00). Intestinal obstruction, anastomosis leakage, abdominal abscess and bleeding produced the greatest impact. Conclusions Minor and major complications were stronger predictors of prolonged hospital stay than preoperative demographic and disease parameters. Compared with the PLOS model, the PPOLOS model better predicted risk of prolonged hospital stay. Optimal surgical and medical care have major roles in surgical CRC patients.

scholarly journals Pre-operative anxiety amongst patients in a tertiary care hospital in India- a prevalence study

2017 ◽  
Vol 4 (1) ◽  
pp. 5-10 ◽  
Author(s):  
Prasanna Vadhanan ◽  
Debendra Kumar Tripaty ◽  
Kiruthika Balakrishnan
Keyword(s):  
Hospital Stay ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Care Hospital ◽  
Cardiac Events ◽  
Contributing Factors ◽  
Previous Surgery ◽  
Female Patients ◽  
Anxiety Levels ◽  
Prolonged Hospital

Background: The prospect of undergoing surgery under anaesthesia can induce significant anxiety in patients. Excess anxiety can lead to several deleterious effects like perioperative cardiac events, increased anaesthetic requirements, higher postoperative pain scores and prolonged hospital stay. Various factors can influence the anxiety levels during surgery. The aim of the study was to estimate the prevalence of anxiety in adult patients scheduled for surgery in a suburban teaching institute in India where the majority of patients belong to lower socioeconomic strata.Methods: One hundred consecutive patients scheduled for various elective surgeries were asked 6 questions according to the Amsterdam preoperative anxiety and information scale to assess their anxiety levels just before shifting into the Operating room. Probable contributing factors noted were age, sex, socioeconomic status, type of surgery, duration of hospital stay, and history of previous surgery. Any specific factors causing anxiety like failure or complications of surgery, recovery from anaesthesia, needle pricks were also asked with leading questions.Results: The overall prevalence of anxiety was 31%. The prevalence in male patients and female patients were 21.2% and 39.5% respectively. There was a moderate correlation between the anxiety scores and need to know scores. The effects of sex, previous surgery, the length of hospital stay were not significant upon the anxiety scores.Conclusion: The overall prevalence of anxiety in the southern part of India was lower when compared to many of the reported studies; however, the prevalence was higher among the female patients. 

scholarly journals Meta-Analysis and Systematic Review of Procalcitonin-Guided Therapy in Respiratory Tract Infections

2011 ◽  
Vol 55 (12) ◽  
pp. 5900-5906 ◽  
Author(s):  
Hui Li ◽  
Yi-Feng Luo ◽  
Timothy S. Blackwell ◽  
Can-Mao Xie
Keyword(s):  
Respiratory Tract ◽  
Antibiotic Therapy ◽  
Hospital Stay ◽  
Respiratory Tract Infections ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
Antibiotic Use ◽  
Controlled Trials ◽  
Randomized Controlled ◽  
Tract Infections

ABSTRACTCirculating procalcitonin (PCT) is a biomarker that can be used in diagnosing bacterial infections. We performed a quantitative meta-analysis of available randomized controlled trials to determine whether antibiotic therapy based on PCT measurements alters clinical outcomes and antibiotic use in patients with lower respiratory tract infections. We identified studies through MEDLINE (1996 to 2010), the ISI Web of Knowledge (1996 to 2010), and Ovid. Studies that met our criteria were prospective, randomized controlled trials involving patients with respiratory tract infections. Outcomes of mortality, intensive care unit (ICU) admission, length of hospital stay, number of antibiotic prescriptions, and duration of antibiotic treatment were evaluated. Eight studies randomizing 3,431 patients met our criteria for inclusion. Pooled analysis showed a significant reduction in number of antibiotic prescriptions and duration of antibiotic use in patients with PCT-guided antibiotic treatment compared to standard therapy. In addition, the use of PCT-guided antibiotic therapy did not impact mortality, ICU admission, or length of hospital stay in these studies. A high degree of heterogeneity was identified in 3 of 5 outcomes that were evaluated, and sensitivity analysis indicated that heterogeneity was decreased among studies using the same PCT-based treatment algorithm. In conclusion, PCT-guided antibiotic therapy in patients with respiratory tract infections appears to reduce antibiotic use without affecting overall mortality or length of stay in the hospital.

scholarly journals Risk of nutritional status on diarrhea among under five children

2015 ◽  
Vol 55 (4) ◽  
pp. 235
Author(s):  
Wiliam Jayadi Iskandar ◽  
I wayan Sukardi ◽  
Yati Soenarto
Keyword(s):  
Logistic Regression ◽  
Nutritional Status ◽  
Hospital Stay ◽  
Acute Diarrhea ◽  
Length Of Hospital Stay ◽  
Watery Diarrhea ◽  
Under Five ◽  
Under Five Children ◽  
Malnourished Children ◽  
Acute Watery Diarrhea

Background Diarrhea is still the leading cause of children’s mortality worldwide and the main cause of malnutrition. Meanwhile, malnourished children are proven to have more severe, prolonged, and frequent episodes of diarrhea, making them a vicious circle.Objective To investigate the risk of nutritional status on diarrheal severity and duration as well as length of hospital stay.Methods We conducted a cross sectional study involving 176 under five children who admitted to Mataram Province Hospital with acute diarrhea since January until December 2013. We analyzed data using logistic regression model.Results Most subjects were infants (median 12 months, range 1-53), male (56.8%), well-nourished (85.8%), admitted with acute watery diarrhea (97.2%), mild-to-moderate dehydration (71.6%), diarrhea severity score ≥11 (74.4%), duration of diarrhea ≤7 days (96.6%), and length of stay <5 days (73.3%). Logistic regression model indicated significant risk of nutritional status on length of hospital stay (adjusted OR 2.09, 95% CI 1.06 to 6.38), but neither diarrheal severity (adjusted OR 1.03, 95% CI 0.38 to 2.80) nor duration of diarrhea (adjusted OR = 1.17, 95% CI = 0.13 to 10.89) indicated significant risks. However, malnourished children had more severe (76% versus 74.2%) and longer duration (4% versus 3.3%) of diarrhea than well-nourished children.Conclusion Nutritional status is the risk for length of hospital stay in under-five children admitted with acute diarrhea. [

scholarly journals Prevalence and factors associated with Group A rotavirus infection among children with acute diarrhea in Mwanza, Tanzania

2011 ◽  
Vol 6 (06) ◽  
pp. 508-515 ◽  
Author(s):  
Akwila Temu ◽  
Erasmus Kamugisha ◽  
Damas L Mwizamholya ◽  
Aldofina Hokororo ◽  
Jeremiah Seni ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Latex Agglutination ◽  
Watery Diarrhea ◽  
Severe Malnutrition ◽  
Cross Sectional ◽  
Rotavirus Infection ◽  
Acute Watery Diarrhea ◽  
Group A ◽  
The Mean ◽  
Prolonged Hospital

Introduction: Rotavirus infections frequently cause acute gastroenteritis in humans and are the most important cause of severe dehydrating diarrhea in young children in both developed and developing countries. Methodology: This was a prospective cross-sectional, hospital-based study on 300 children ≤ 5 years with acute watery diarrhea who attended Bugando Medical Centre (BMC) and Nyamagana District hospital between May and November 2009. Stool specimens were tested for rotavirus infection using latex agglutination test. Data were cleaned and analyzed using SPSS 11.0. Results: Of 300 children with acute watery diarrhea, 136 (45.3%) were female and the mean age was 12.63 months (SD = 10.4). Sixty-two (20.7%) children were found to have rotavirus infection. Of children with severe malnutrition three (37.5%) were infected with rotavirus. Fifty-two (84%) of children with rotavirus infection were below two years of age. Severe dehydration was present in 48 (16%) children of whom 12 (25%) were infected with rotavirus compared to 18 (16.6%) of 109 children with no dehydration. Living next door to a child with diarrhea was highly associated with rotavirus infection (43% versus 19%; p = 0.036). The mean hospital stay among children with rotavirus infection was 3.66 days versus 2.5 days for those without rotavirus (p = 0.005).      Conclusion: Rotavirus infection is prevalent in Mwanza region and contributes to prolonged hospital stay. Proper education on hygiene to control diarrheal diseases among children should be emphasized. Extensive studies to determine the serotypes of rotavirus are warranted in the region before rotavirus vaccine is introduced.

scholarly journals A Study of Factors Affecting the Length of Hospital Stay of COVID-19 Patients by Cox-Proportional Hazard Model in a South Indian Tertiary Care Hospital

2021 ◽  
Vol 12 ◽  
pp. 215013272110002
Author(s):  
Gayathri Thiruvengadam ◽  
Marappa Lakshmi ◽  
Ravanan Ramanujam
Keyword(s):  
Hospital Stay ◽  
Tertiary Care ◽  
Length Of Hospital Stay ◽  
Hazard Model ◽  
Cox Proportional Hazard Model ◽  
Care Hospital ◽  
Proportional Hazard ◽  
Proportional Hazard Model ◽  
Cox Proportional Hazard ◽  
South Indian

Background: The objective of the study was to identify the factors that alter the length of hospital stay of COVID-19 patients so we have an estimate of the duration of hospitalization of patients. To achieve this, we used a time to event analysis to arrive at factors that could alter the length of hospital stay, aiding in planning additional beds for any future rise in cases. Methods: Information about COVID-19 patients was collected between June and August 2020. The response variable was the time from admission to discharge of patients. Cox proportional hazard model was used to identify the factors that were associated with the length of hospital stay. Results: A total of 730 COVID-19 patients were included, of which 675 (92.5%) recovered and 55 (7.5%) were considered to be right-censored, that is, the patient died or was discharged against medical advice. The median length of hospital stay of COVID-19 patients who were hospitalized was found to be 7 days by the Kaplan Meier curve. The covariates that prolonged the length of hospital stay were found to be abnormalities in oxygen saturation (HR = 0.446, P < .001), neutrophil-lymphocyte ratio (HR = 0.742, P = .003), levels of D-dimer (HR = 0.60, P = .002), lactate dehydrogenase (HR = 0.717, P = .002), and ferritin (HR = 0.763, P = .037). Also, patients who had more than 2 chronic diseases had a significantly longer length of stay (HR = 0.586, P = .008) compared to those with no comorbidities. Conclusion: Factors that are associated with prolonged length of hospital stay of patients need to be considered in planning bed strength on a contingency basis.

565 POST-OPERATIVE WEIGHT LOSS AND OUTCOMES FOLLOWING ESOPHAGECTOMY

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
R Khaw ◽  
S Munro ◽  
J Sturrock ◽  
H Jaretzke ◽  
S Kamarajah ◽  
...  
Keyword(s):  
Weight Loss ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Failure To Thrive ◽  
Post Discharge ◽  
Postoperative Weight Loss ◽  
Poor Outcomes ◽  
The Impact

Abstract   Oesophageal cancer is the 11th most common cancer worldwide, with oesophagectomy remaining the mainstay curative treatment, despite significant associated morbidity and mortality. Postoperative weight loss remains a significant problem and is directly correlated to poor prognosis. Measures such as the Enhanced Recovery After Surgery (ERAS) programme and intraoperative jejunostomy feed have looked to tackle this. This study investigates the impact of these on mortality, length of hospital stay and postoperative weight loss. Methods Patients undergoing oesophagectomy between January 1st 2012—December 2014 and 28th October 2015–December 31st 2019 in a national tertiary oesophagogastric unit were included retrospectively. Variables measured included comorbidities, operation, histopathology, weights (pre- and post-operatively), length of hospital stay, postoperative complications and mortality. Pre-operative body weight was measured at elective admission, and further weights were identified from a prospectively maintained database, during further clinic appointments. Other data was collected through patient notes. Results 594 patients were included. Mean age at diagnosis was 65.9 years (13–65). Majority of cases were adenocarcinoma (63.3%), with varying stages of disease (TX-4, NX-3). Benign pathology accounted for 8.75% of cases. Mean weight loss post-oesophagectomy exceeded 10% at 6 months (SD 14.49). Majority (60.1%) of patients were discharged with feeding jejunostomy, and 5.22% of these required this feed to be restarted post-discharge. Length of stay was mean 16.5 days (SD 22.3). Complications occurred in 68.9% of patients, of which 13.8% were infection driven. Mortality occurred in 26.6% of patients, with 1.83% during hospital admission. 30-day mortality rate was 1.39%. Conclusion Failure to thrive and prolonged weight-loss following oesophagectomy can contribute to poor recovery, with associated complications and poor outcomes, including increased length of stay and mortality. Further analysis of data to investigate association between weight loss and poor outcomes for oesophagectomy patients will allow for personalised treatment of high-risk patients, in conjunction with members of the multidisciplinary team, including dieticians.

237 Stable Performance with Reduced Antibiotic Use in Piglets Vaccinated with an E. coli F4/F18 Vaccine for the Prevention of F18-ETEC Post-weaning Diarrhea

2021 ◽  
Vol 99 (Supplement_1) ◽  
pp. 139-140
Author(s):  
Frédéric A Vangroenweghe
Keyword(s):  
Antibiotic Use ◽  
Watery Diarrhea ◽  
Economic Losses ◽  
Standard Group ◽  
Performance Parameters ◽  
Oral Vaccination ◽  
E Coli ◽  
Technical Performance ◽  
Stable Performance ◽  
The Impact

Abstract Post-weaning Escherichia coli diarrhea (PWD) remains a major cause of economic losses for the pig industry. PWD, caused by enterotoxigenic E. coli (ETEC), typically provokes mild to severe watery diarrhea between 5–10 days after weaning. Recently, an oral live bivalent E. coli F4/F18 vaccine (Coliprotec® F4/F18; Elanco) was approved on the European market, which reduces the impact of PWD provoked by F4-ETEC and F18-ETEC. The objective was to compare technical results and antibiotic use following E. coli F4/F18 vaccination with previous standard therapeutic approach under field conditions. A 1600-sow farm (weaning at 26 days) with diagnosed problems of PWD due to F18-ETEC was selected. Piglets were vaccinated at 21 days with the oral live bivalent E. coli F4/F18 vaccine. At weaning, no standard group medication (ZnO and antibiotics) was applied for prevention of PWD. Several performance parameters were collected: treatment incidence (TI100), mortality and days in nursery. Statistical analysis was performed using JMP 14.0 – comparison of means. Oral E. coli F4/F18 vaccination significantly reduced TI100 (7 ± 2 days to 0 ± 1 days; P &lt; 0.05). Mortality rate remained stable (2.05% in Control to 1.96% in Vaccinated group; P &lt; 0.05). Days in nursery (40 ± 3 days) remained at the same level compared to pre-vaccination. The results show that live E. coli F4/F18 vaccination against PWD has led to similar technical performance parameters and mortality, in combination with a significant reduction in medication use. In conclusion, control of PWD through oral vaccination is a successful option in order to prevent piglets from the negative clinical outcomes of F18-ETEC infection during the post-weaning period.

The Association between Prolonged Antibiotic Use in Culture Negative Infants and Length of Hospital Stay and Total Hospital Costs

2021 ◽  
Author(s):  
Wesam Sourour ◽  
Valeria Sanchez ◽  
Michel Sourour ◽  
Jordan Burdine ◽  
Elizabeth Rodriguez Lien ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Culture ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Antibiotic Use ◽  
Hospital Length Of Stay ◽  
Control Group ◽  
Multivariate Linear Regression Analysis ◽  
Negative Blood Culture ◽  
Total Cost

Objective This study aimed to determine if prolonged antibiotic use at birth in neonates with a negative blood culture increases the total cost of hospital stay. Study design This was a retrospective study performed at a 60-bed level IV neonatal intensive care unit. Neonates born <30 weeks of gestation or <1,500 g between 2016 and 2018 who received antibiotics were included. A multivariate linear regression analysis was conducted to determine if clinical factors contributed to increased hospital cost or length of stay. Results In total, 190 patients met inclusion criteria with 94 infants in the prolonged antibiotic group and 96 in the control group. Prolonged antibiotic use was associated with an increase length of hospital stay of approximately 31.87 days, resulting in a $69,946 increase in total cost of hospitalization. Conclusion Prolonged antibiotics in neonates with negative blood culture were associated with significantly longer hospital length of stay and increased total cost of hospitalization. Key Points

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