scholarly journals Benefits of Pharmacist Intervention in the Critical Care Geriatric Patients with Infectious Diseases: A Propensity Score Matching Retrospective Cohort Study

2021 ◽  
Author(s):  
Hongyan Gu ◽  
Lulu Sun ◽  
Bo Sheng ◽  
Xuyun Gu ◽  
Suozhu Wang ◽  
...  
Keyword(s):  
Critical Care ◽  
Infectious Diseases ◽  
Retrospective Cohort ◽  
Geriatric Patients ◽  
Antibiotic Use ◽  
Pharmacist Intervention ◽  
Control Group ◽  
Medication Regimen ◽  
Icu Patients ◽  
Bed Days

Abstract Background The variabilities of the pharmacotherapeutics’ efficacy and safety in the ICU geriatric patients further highlighted the importance of optimization of antimicrobial therapy. The aim of our study was to assess the impacts of clinical pharmacist intervention on antibiotic use, cost outcomes, and clinical benefits of the geriatric patients with infectious diseases in the critical care unit (ICU). Methods A propensity score matching (PSM) retrospective cohort study was undertaken in ICU patients with infectious diseases from 2017 to 2019. Baseline demographic, pharmacists’ activities and clinical outcomes including the patients’ mortality, antibiotic utilization, length of ICU stay (LOS), and costs of the drugs were compared between these two groups. Univariate analysis and bivariate logistic regression were adopted to illustrate the influencing factors on the mortality outcome. Results Of 1523 patients evaluated during the observed period, a total of 102 geriatric ICU patients with infectious diseases were enrolled in each group after PSM matching. Top 5 recommendations occurred by the pharmacist were medication regimen adjustments by diseases on progression, medication regimen adjustments by microbial results, drug withdrawal by full treatment courses, suggestions for TDM and medication regimen adjustments by de-escalation. The antibiotic use density (AUD) of all antibiotics consumed decreased significantly (p=0.018) from 241.91 DDD/100 bed days in the control group to 176.64 DDD/100 bed days in the pharmacist exposed group. AUD proportion was dropped in carbapenems from 23.07% to 14.43% and tetracyclines from 11.56% to 6.26% after pharmacist interventions. Although the mortality or LOS had no statistical difference between these two groups, the total cost of antibiotics was reduced significantly from $836.3 (IQR 426.88, 1682.09) in the control group to $362.15 (IQR 148.23, 1034.4) (p＜0.001) in the pharmacist intervention group, and cost for all the medications were reduced from $2868.18 ($1268.44, $5059.00) to $1941.5 ($1092.89, $3538.97) (p=0.016). Univariate analyses showed that there was no statistically difference in pharmacist intervention between the groups of survival and death (p=0.288) Conclusions The services provided by the critical care pharmacist could promote the rational use of drugs, which benefit both ICU geriatric patient and hospital care.

The Year in Review: Critical Care Medicine

2001 ◽  
Vol 14 (1) ◽  
pp. 70-85
Author(s):  
Maria I. Rudis ◽  
David Q. Hoang
Keyword(s):  
Critical Care ◽  
Cardiovascular Diseases ◽  
Infectious Diseases ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Treatment Guidelines ◽  
Neuromuscular Blocking ◽  
Critical Care Medicine ◽  
Icu Patients ◽  
Adult Intensive Care Unit

Background: There have been significant recent advances in the pharmacotherapeutic management of critically ill patients. The purpose of this article is to review and discuss the most pertinent published literature in the areas of neurology, cardiovascular diseases, infectious diseases, nephrology, hematology, and gastroenterology as it pertains to critical care in order to provide an update for the critical care practitioner. Methods: We performed a Medline search from July 1999 to December 2000 utilizing terms relating to the pharmacotherapy of the specific aforementioned topics in critical care medicine. We focused on English-language clinical studies performed in adult intensive care unit (ICU) patients. From these articles we selected those that would have a practical impact on drug therapy in the ICU or the development of drug usage guidelines for critically ill patients. Review articles were generally not included. Results: The following topics were found to be either new developments or of potentially significant impact in the management of adult critically ill patients. In the area of neurology, advances were found with respect to optimization of regimens for sedative and neuromuscular blocking agents, validation of sedation scales and tools, and in the treatment of head injury patients. In the cardiovascular diseases, most studies related to the hemodynamic support of septic shock. We focus on developments in fluid resuscitation, optimization of global and regional oxygen transport variables, the repositioning of vasopressor agents, and a return to the use of steroids. Given the high mortality rate associated with the development of acute renal failure in the ICU, there has been a consistent attempt to develop preventative and treatment strategies for these patients, including optimization of antimicrobial dosing methods. Several epidemiological and longitudinal studies document changes in multi-drug antimicrobial resistance patterns. The use of treatment guidelines for antimicrobials in the critically ill improves outcomes in most patients. Significant attention has focused on the characterization of anemia in the ICU and the development of alternative pharmacological strategies in its treatment. Finally, in gastroenterology, the main focus has been the investigation of methods to optimize the delivery of enteral nutrition given its proven benefits in critically ill patients. Conclusions: Significant advances in the areas of neurological, cardiovascular, infectious diseases, renal, hematological, and gastrointestinal issues in the pharmacotherapy of critically ill patients have been published over the course of the past year. Many of these studies have yielded data that may be incorporated into the pharmacotherapeutic management of ICU patients, hence maximizing outcomes.

scholarly journals Effects of Chengqi Decoction on Complications and Prognosis of Patients with Pneumonia-Derived Sepsis: Retrospective Cohort Study

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Zhipeng Huang ◽  
Xiaoxin Cai ◽  
Yao Lin ◽  
Bojun Zheng ◽  
Li Jian ◽  
...  
Keyword(s):  
Treatment Group ◽  
Retrospective Cohort ◽  
Conventional Treatment ◽  
Abdominal Distension ◽  
Antibiotic Use ◽  
Control Group ◽  
Vasoactive Agents ◽  
Mortality And Morbidity ◽  
And Control ◽  
Significant Covariates

Purpose. A specific and efficacious method for treatment of pneumonia-derived sepsis is lacking. Chengqi decoction has been used for treatment of pneumonia-derived sepsis, but a clinical trial on patients with pneumonia-derived sepsis is lacking, a gap in the literature that we sought to fill. Patients and Methods. 282 patients with pneumonia-derived sepsis admitted to the intensive care unit of our hospital were selected. They were divided into the treatment group (141 cases) and control group (141 cases). Both groups underwent conventional treatment, but Chengqi decoction (in the form of enema) was given to the treatment group. Mortality, morbidity (abdominal distension and gastrointestinal bleeding), duration of antibiotic use, and use of vasoactive agents were documented 28 days after the drug was used. Results. The treatment group reduced mortality and morbidity (abdominal distension) ( P < 0.05 ). After adjustment for significant covariates, 28-day survival was similar for the whole group (hazard ratio (HR): 0.48; 95% confidence interval (CI): 0.23–0.97; P = 0.037 ), for the subgroup (n = 120) with Acute Physiology and Chronic Health Evaluation II score ≥25 (HR: 0.180; 95% CI: 0.032–0.332; P = 0.039 ) and for the subgroup (n = 66) with N-terminal B-type natriuretic peptide <1800 (0.059, 0.004–0.979, and 0.019). There was no difference between the two groups for the duration of antibiotic use, major bleeding, or use of vasoactive drugs. Conclusions. Chengqi decoction improved 28-day survival and reduced the prevalence of abdominal distension in patients with pneumonia-derived sepsis.

Effect of Pharmacist Intervention on 30-Adverse Drug Event after Discharge in Elderly Patients through a Comprehensive Medication Reconciliation: A Randomized Clinical Trial

2021 ◽  
Author(s):  
SunMin Lee ◽  
Yun Mi Yu ◽  
Euna Han ◽  
Min Soo Park ◽  
Jung-Hwan Lee ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Randomized Clinical Trial ◽  
Medication Reconciliation ◽  
Intervention Group ◽  
Pharmacist Intervention ◽  
Phone Call ◽  
Control Group ◽  
Medication Regimen ◽  
Medication Regimen Complexity ◽  
Regimen Complexity

Abstract Polypharmacy can cause drug-related problems, such as potentially inappropriate medication (PIM) use and medication regimen complexity in the elderly. This comprehensive medication reconciliation study was designed as a prospective, open-label, randomized clinical trial with patients aged 65 years or older from July–December 2020. Comprehensive medication reconciliation comprises medication reviews based on the PIM criteria. The discharge of medication was simplified to reduce regimen complexity. Changes in regimen complexity were evaluated using the Korean version of the medication regimen complexity (MRCI-K). Adverse drug events (ADEs) were monitored throughout hospitalization and 30 days after discharge. Of the 32 patients, 34.4% (n = 11) reported ADEs before discharge, and 19.2% (n = 5) ADEs were reported at the 30-day phone call. No ADEs were reported in the intervention group, whereas five events were reported in the control group (p = 0.039) on the 30-day phone call. The intervention group showed a greater score reduction than the control group in terms of the number of medications, MRCI-K, and PIMs. As a result of the pharmacist intervention, we identified the feasibility of pharmacist-led interventions using comprehensive medication reconciliation, including the criteria of the PIMs and the MRCI-K, and the differences in ADEs between the intervention and control groups at the 30-day follow-up after discharge (Clinical trial number: KCT0005994, 03/12/2021).

scholarly journals Effect of critical care pharmacist on antibiotic medication optimizations, reduce drug costs but not increase mortality: A retrospective cohort study in the real world research

2020 ◽  
Author(s):  
Hongyan Gu ◽  
Lulu Sun ◽  
Bo Sheng ◽  
Xuyun Gu ◽  
Suozhu Wang ◽  
...  
Keyword(s):  
Critical Care ◽  
Cohort Study ◽  
Real World ◽  
Clinical Pharmacist ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Professional Training ◽  
Drug Costs ◽  
Intervention Period ◽  
Medication Regimen

Abstract Background We aims to investigate the roles of clinical pharmacist on optimizing the antibiotic pharmacotherapy regimens and achieved better clinical and economic outcomes in the critical care unit (ICU). Methods A retrospective cohort study in real world was undertaken from the year of 2016 to 2017 as the pharmacist pre-intervention period and 2018 to 2019 as the pharmacist intervention period in ICU. All interventions and consensus with clinicians were recorded. The outcomes of the patients’ mortality, microorganism detections, antibiotic utilities, length of ICU stay (LOS), costs of the antibiotics and the total drugs used were reviewed. Results Of 1436 patients were evaluated and 1252 recommendations were identified. The main points of the pharmacist interventions were medication regimen adjustments (52.32%) and drug withdrawal (22.60%). Before and after the pharmaceutical interventions, the AUD of all antimicrobials consumed decreased from 211.83 to174.02 (p = 0.000), the rate of antimicrobial utility decreased from 89.88–86.82% (p = 0.001), mortality reduced from 18.73–15.21% (p = 0.002), antibiotic charges were from ࿥8,644 ± 12,556 to ࿥5,587 ± 7,606 (p = 0.000) with 39% reduction. Conclusions The services provided by the clinical pharmacist with highly professional training could optimize the antibiotic therapy regimes, saved the drug costs and did not increase mortalities.

scholarly journals The impact of universal cardiopulmonary exercise testing on perioperative pathways and short-term patient outcomes following elective pancreatic surgery: A retrospective cohort study

2021 ◽  
pp. 175114372110221
Author(s):  
Sophie Mathoulin ◽  
Gary Minto ◽  
Gordon Taylor ◽  
Paul Erasmus
Keyword(s):  
Critical Care ◽  
Retrospective Cohort ◽  
Pancreatic Surgery ◽  
Cardiopulmonary Exercise Testing ◽  
Complication Rates ◽  
Cardiopulmonary Exercise ◽  
Period 2 ◽  
Critical Care Admission ◽  
Bed Days ◽  
The Impact

Background The utility of Cardiopulmonary Exercise Testing (CPET) to identify higher risk surgical patients remains controversial. There is limited research investigating the value of preoperative CPET to plan perioperative pathways for patients undergoing major pancreatic surgery. Methods Retrospective cohort study, comprising two groups before and after a change in referral policy for High Risk preoperative anaesthetic clinic with CPET. Period 1 discretionary referral and Period 2: universal referral. The primary aim was to investigate the impact of this policy change on critical care use (planned vs unplanned) on the day of surgery and on delayed critical care admission. Secondary end points included a comparison of the total number of critical care bed days, days in hospital, complication rates and mortality data between the two cohorts. Results 177 patients were included; 114 in Period 1 and 63 in Period 2. There was a reduction in unplanned day of surgery postoperative admissions to critical care (28.1% vs. 11.1%, p = 0.008). Seven (6.1%) of patients in Period 1 and 1 (1.6%) patient in Period 2 had delayed admission, though no p value was calculated due to the small numbers involved. Complication rates were similar in each group. The median critical care bed days was 1 (range 0–21) days in Period 1 and 1 (0–13) days in Period 2. Conclusions A universal referral policy for preoperative CPET demonstrated a decrease in unplanned day of surgery critical care admissions and a trend towards reducing delayed (>24 h postop) critical care admission which could be investigated in a larger study. No measurable impact was seen on clinical outcomes.

Urine Culture on Admission Impacts Antibiotic Use and Length of Stay: A Retrospective Cohort Study

2018 ◽  
Vol 39 (5) ◽  
pp. 547-554 ◽  
Author(s):  
Molly J. Horstman ◽  
Andrew M. Spiegelman ◽  
Aanand D. Naik ◽  
Barbara W. Trautner
Keyword(s):  
Cohort Study ◽  
Length Of Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Urine Culture ◽  
Antibiotic Use ◽  
The United States ◽  
Targeted Interventions ◽  
Bed Days ◽  
The Impact

OBJECTIVETo examine the impact of urine culture testing on day 1 of admission on inpatient antibiotic use and hospital length of stay (LOS).DESIGNWe performed a retrospective cohort study using a national dataset from 2009 to 2014.SETTINGThe study used data from 230 hospitals in the United States.PARTICIPANTSAdmissions for adults 18 years and older were included in this study. Hospitalizations were matched with coarsened exact matching by facility, patient age, gender, Medicare severity-diagnosis related group (MS-DRG), and 3 measures of disease severity.METHODSA multilevel Poisson model and a multilevel linear regression model were used to determine the impact of an admission urine culture on inpatient antibiotic use and LOS.RESULTSMatching produced a cohort of 88,481 patients (n=41,070 with a culture on day 1, n=47,411 without a culture). A urine culture on admission led to an increase in days of inpatient antibiotic use (incidence rate ratio, 1.26; P<.001) and resulted in an additional 36,607 days of inpatient antibiotic treatment. Urine culture on admission resulted in a 2.1% increase in LOS (P=.004). The predicted difference in bed days of care between admissions with and without a urine culture resulted in 6,071 additional bed days of care. The impact of urine culture testing varied by admitting diagnosis.CONCLUSIONSPatients with a urine culture sent on day 1 of hospital admission receive more days of antibiotics and have a longer hospital stay than patients who do not have a urine culture. Targeted interventions may reduce the potential harms associated with low-yield urine cultures on day 1.Infect Control Hosp Epidemiol 2018;39:547–554

Is perioperative antibiotic necessary in straightforward implant placement procedures?

2020 ◽  
Author(s):  
Elçin Bedeloğlu ◽  
Mustafa Yalçın ◽  
Cenker Zeki Koyuncuoğlu
Keyword(s):  
Clavulanic Acid ◽  
Dental Implant ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
Implant Failure ◽  
Control Group ◽  
Implant Placement ◽  
Significant Difference ◽  
Amoxicillin Clavulanic Acid ◽  
Experimental Group

The purpose of this non-random retrospective cohort study was to evaluate the impact of prophylactic antibiotic on early outcomes including postoperative pain, swelling, bleeding and cyanosis in patients undergoing dental implant placement before prosthetic loading. Seventy-five patients (45 males, 30 females) whose dental implant placement were completed, included to the study. Patients used prophylactic antibiotics were defined as the experimental group and those who did not, were defined as the control group. The experimental group received 2 g amoxicillin + clavulanic acid 1 h preoperatively and 1 g amoxicillin + clavulanic acid twice a day for 5 days postoperatively while the control group had received no prophylactic antibiotic therapy perioperatively. Data on pain, swelling, bleeding, cyanosis, flap dehiscence, suppuration and implant failure were analyzed on postoperative days 2, 7, and 14 and week 12. No statistically significant difference was detected between the two groups with regard to pain and swelling on postoperative days 2, 7, and 14 and week 12 ( p &gt;0.05), while the severity of pain and swelling were greater on day 2 compared to day 7 and 14 and week 12 in both groups ( p =0.001 and p &lt;0.05, respectively). Similarly, no significant difference was found between the two groups with regard to postoperative bleeding and cyanosis. Although flap dehiscence was more severe on day 7 in the experimental group, no significant difference was found between the two groups with regard to the percentage of flap dehiscence assessed at other time points. Within limitations of the study, it has been demonstrated that antibiotic use has no effect on implant failure rates in dental implant surgery with a limited number of implants. We conclude that perioperative antibiotic use may not be required in straightforward implant placement procedures. Further randomized control clinical studies with higher numbers of patients and implants are needed to substantiate our findings.

scholarly journals Incidence of Kawasaki disease before and during the COVID-19 pandemic: a retrospective cohort study in Japan

2021 ◽  
Vol 5 (1) ◽  
pp. e001034
Author(s):  
Kyohei Iio ◽  
Kousaku Matsubara ◽  
Chisato Miyakoshi ◽  
Kunitaka Ota ◽  
Rika Yamaoka ◽  
...  
Keyword(s):  
Cohort Study ◽  
Kawasaki Disease ◽  
Infectious Diseases ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Bacterial Infections ◽  
Epidemiological Studies ◽  
Primary Objective ◽  
Temporal Association ◽  
Difference In Difference

BackgroundEpidemiological studies in Kawasaki disease (KD) have suggested infectious aetiology. During the COVID-19 pandemic, measures for mitigating SARS-CoV-2 transmission also suppress the circulation of other contagious microorganisms. The primary objective is to compare the number and incidence of KD before and during the COVID-19 pandemic in Japan, and the secondary objective is to investigate temporal association between the KD epidemiology and activities of SARS-CoV-2 and other viral and bacterial infections.MethodsA retrospective cohort study was conducted between 2016 and 2020 in Kobe, Japan. We collected information of hospitalised KD children in Kobe. Child population was identified through the resident registry system. Activity of COVID-19 and 11 other infectious diseases was derived from a public health monitoring system. Monthly change of KD incidence was analysed using a difference-in-difference regression model.ResultsThroughout the study period, 1027 KD children were identified. KD had begun to decline in April 2020, coinciding with the beginning of the COVID-19 pandemic. The number of KD cases (n=66) between April and December 2020 was 40% of the average in the same period in 2016–2019 (165/year). Annual KD incidence was 315, 300, 353, 347 and 188/100 000 children aged 0–4 years in 2016–2020, respectively. The difference-in-difference value of KD incidence was significantly reduced in the fourth quarter in 2020 (−15.8, 95% CI −28.0 to −3.5), compared with that in 2016–2019. Sentinel surveillance showed a marked decrease of all infectious diseases except exanthema subitum after the beginning of the COVID-19 pandemic. There were 86 COVID-19 cases aged <10 years and no KD children associated with COVID-19.ConclusionThis study showed that the number and incidence of KD was dramatically reduced during the COVID-19 pandemic in Japan. This change was temporally associated with decreased activities of various infectious diseases other than COVID-19, supporting the hypothesis of infection-triggered pathogenesis in KD.

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