scholarly journals Effectiveness of empirical anti-pseudomonal antibiotics in patients with recurrent COPD exacerbation: A multicenter retrospective cohort study

2021 ◽  
Author(s):  
Akihiro Shiroshita ◽  
Chisato Miyakoshi ◽  
Shunta Tsutsumi ◽  
Hiroshi Shiba ◽  
Chigusa Shirakawa ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Fixed Effects ◽  
Large Scale ◽  
Chronic Obstructive ◽  
Systemic Steroid ◽  
Copd Exacerbation ◽  
Copd Exacerbations

Abstract Background: Although frequent chronic obstructive pulmonary disease (COPD) exacerbation has been associated with the isolation of Pseudomonas aeruginosa (PA) in sputum cultures, it remains unknown whether the empirical use of anti-pseudomonal antibiotics can improve outcomes in patients with frequent COPD exacerbations. Research Question: Does empirical use of anti-pseudomonal antibiotics improve the length of the hospital stay in patients with recurrent COPD exacerbation?Study Design and Methods: This multicenter retrospective cohort study was conducted in seven hospitals in Japan. We included patients aged ≥40 years who were admitted to the hospital with COPD exacerbation more than twice during the study period (April 1, 2008 to July 31, 2020). The primary outcome was the length of the hospital stay. For statistical analysis, a log-linked Gamma model was used. Parameters were estimated using a generalized estimating equation model with an exchangeable correlation structure accounting for repeated observations from a single patient. Covariates included age, body mass index, home oxygen therapy use, respiratory rate, heart rate, oxygen use on admission, mental status, systemic steroid use, activities of daily living, and number of recurrences. Hospital-specific effects were specified as fixed effects.Results: Among 1573 patients with COPD exacerbation, 344 patients and 965 observations of recurrent COPD exacerbations were selected. Anti-pseudomonal antibiotics were used in 173 patients (18%). The estimated change in the length of the hospital stay between the anti-pseudomonal and non-anti-pseudomonal antibiotics groups was 0.044 days [95% confidence interval; -0.077, 0.166]. Interpretation: Use of empirical anti-pseudomonal antibiotics based only on recurrence may not be necessary. Further large-scale studies are needed to more precisely evaluate the effectiveness of empirical anti-pseudomonal antibiotics.

scholarly journals Effectiveness of empirical anti-pseudomonal antibiotics for recurrent COPD exacerbation: a multicenter retrospective cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Akihiro Shiroshita ◽  
Chisato Miyakoshi ◽  
Shunta Tsutsumi ◽  
Hiroshi Shiba ◽  
Chigusa Shirakawa ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Fixed Effects ◽  
Estimating Equation ◽  
Chronic Obstructive ◽  
Systemic Steroid ◽  
Copd Exacerbation ◽  
Copd Exacerbations

AbstractAlthough frequent chronic obstructive pulmonary disease (COPD) exacerbation has been associated with the isolation of Pseudomonas aeruginosa (PA) in sputum cultures, it remains unknown whether the empirical use of anti-pseudomonal antibiotics can improve outcomes in patients with frequent COPD exacerbations. This multicenter retrospective cohort study evaluated whether the empirical use of anti-pseudomonal antibiotics improves the length of the hospital stay in patients with recurrent COPD exacerbation (≥ 2 admissions from April 1, 2008 to July 31, 2020). For statistical analysis, a log-linked Gamma model was used. Parameters were estimated using a generalized estimating equation model with an exchangeable correlation structure accounting for repeated observations from a single patient. Covariates included age, body mass index, home oxygen therapy use, respiratory rate, heart rate, oxygen use on admission, mental status, systemic steroid use, activities of daily living, and the number of recurrences. Hospital-specific effects were specified as fixed effects. In total, 344 patients and 965 observations of recurrent COPD exacerbations were selected. Anti-pseudomonal antibiotics were used in 173 patients (18%). The estimated change in the length of the hospital stay between anti-pseudomonal and non-anti-pseudomonal antibiotics groups was 0.039 days [95% confidence interval; − 0.083, 0.162]. Anti-pseudomonal antibiotics could not shorten the length of the hospital stay.

scholarly journals Effectiveness of Empirical Anti-pseudomonal Antibiotics Recurrent COPD Exacerbation: a Multicenter Retrospective Cohort Study

2021 ◽  
Author(s):  
Akihiro Shiroshita ◽  
Chisato Miyakoshi ◽  
Shunta Tsutsumi ◽  
Hiroshi Shiba ◽  
Chigusa Shirakawa ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Stay ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Fixed Effects ◽  
Estimating Equation ◽  
Chronic Obstructive ◽  
Systemic Steroid ◽  
Copd Exacerbation ◽  
Copd Exacerbations

Abstract Although frequent chronic obstructive pulmonary disease (COPD) exacerbation has been associated with the isolation of Pseudomonas aeruginosa (PA) in sputum cultures, it remains unknown whether the empirical use of anti-pseudomonal antibiotics can improve outcomes in patients with frequent COPD exacerbations. This multicenter retrospective cohort study evaluated whether the empirical use of anti-pseudomonal antibiotics improves the hospital stay length in patients with recurrent COPD exacerbation (>2 admissions from April 1, 2008 to July 31, 2020). For statistical analysis, a log-linked Gamma model was used. Parameters were estimated using a generalized estimating equation model with an exchangeable correlation structure accounting for repeated observations from a single patient. Covariates included age, body mass index, home oxygen therapy use, respiratory rate, heart rate, oxygen use on admission, mental status, systemic steroid use, activities of daily living, and number of recurrences. Hospital-specific effects were specified as fixed effects. In total, 344 patients and 965 observations of recurrent COPD exacerbations were selected. Anti-pseudomonal antibiotics were used in 173 patients (18%). The estimated change in hospital stay length between anti-pseudomonal and non-anti-pseudomonal antibiotics groups was 0.044 days [95% confidence interval; -0.077, 0.166]. Thus, the use of empirical anti-pseudomonal antibiotics based only on recurrence may not be necessary.

scholarly journals Effectiveness of a 23-valent Polysaccharide Vaccine in Preventing Pneumonia and Non-invasive Pneumococcal Infection in Elderly People: A Large-scale Retrospective Cohort Study

2005 ◽  
Vol 33 (5) ◽  
pp. 490-500 ◽  
Author(s):  
F Ansaldi ◽  
V Turello ◽  
P Lai ◽  
G Bastone ◽  
S De Luca ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Admission ◽  
Otitis Media ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Large Scale ◽  
Pneumococcal Infection ◽  
Acute Otitis Media ◽  
Polysaccharide Vaccine ◽  
Chronic Obstructive

This retrospective cohort study evaluated the effectiveness of a 23-valent pneumococcal polysaccharide vaccine in reducing hospital admission for pneumonia, otitis media and exacerbation of asthma or other syndromes due to Streptococcus pneumoniae in 9170 high-risk individuals. Cohort members were followed from 1 January 1998 to 31 December 2002. With regard to preventing hospitalization due to pneumonia, we observed a decrease in the incidence of 1/10 000 person-months and a reduction in the relative risk of 38% in the vaccinated cohort compared with the non-vaccinated subjects. A decrease in the risk of hospital admission for asthma, acute otitis media, chronic obstructive pulmonary disease and other respiratory infections was also observed in vaccinated compared with non-vaccinated subjects. The specificity of these findings was confirmed by the lack of a protective effect from vaccination for those outcomes, such as hospitalization ‘for all causes’ and ‘other otorhinolaryngological diagnoses’, that were not directly related to pneumococcal disease.

scholarly journals 24. Economic Burden of Herpes Zoster Among Individuals with Chronic Obstructive Pulmonary Disease: A Retrospective Cohort Study

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S35-S36
Author(s):  
Parinaz Ghaswalla ◽  
Philippe Thompson-Leduc ◽  
Wendy Y Cheng ◽  
Colin Kunzweiler ◽  
Min-Jung Wang ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Cohort Study ◽  
Herpes Zoster ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Chronic Obstructive ◽  
Research Support ◽  
Obstructive Pulmonary Disease ◽  
Material Support ◽  
Analysis Group

Abstract Background Previous studies have evaluated the risk of developing herpes zoster (HZ) in patients with chronic obstructive pulmonary disease (COPD), but little is known about the impact of an acute HZ episode on healthcare resource utilization (HCRU) and costs among patients with COPD in the US. Methods A retrospective cohort study of individuals ≥50 years of age was conducted using administrative claims data from Optum Clinformatics for commercially insured and Medicare Advantage members (01/01/2013 – 12/31/2018). Two cohorts of patients with COPD, with (Cohort A) and without (Cohort B) HZ episodes, were identified (Fig.1). COPD and HZ were identified using ICD-9 and ICD-10 diagnosis codes. All-cause HCRU rates were compared between cohorts using adjusted incidence rate ratios (IRRs), calculated using generalized linear models assuming a negative binomial distribution. Differences in all-cause costs were estimated by fitting a two-part model with a logit model in the first part and a gamma distribution for the second part. Potential differences between cohorts were accounted for by propensity scores, calculated using patients’ demographics and clinical characteristics at baseline and included as a covariate in multivariable regression analyses. Results Among patients with COPD, 3,415 patients with HZ (mean age [standard deviation]=73.2 [9.0] years) and 35,360 without HZ (72.4 [9.4] years) were identified. Compared to patients with COPD but without HZ, patients with COPD and HZ had an increased rate of all-cause outpatient visits (adjusted IRR=1.18; 95% confidence interval [CI]=1.15–1.22; p< 0.001) and Emergency Department visits (1.28; 1.20–1.35; p< 0.001) as well as higher all-cause total costs (adjusted cost difference, per patient per month [PPPM]=$313; 95% CI=$110–536; p< 0.004), in the first year of the observation period. All-cause mean costs PPPM and differences between cohorts were higher closer to the date of HZ diagnosis (or an imputed date for Cohort B, Fig.2). Figure 2: All-cause monthly costs Conclusion HCRU and cost burden is higher in patients ≥50 years old with COPD and HZ vs. without HZ. HZ vaccination may potentially reduce this burden among patients with COPD. Funding GlaxoSmithKline Biologicals SA (GSK study identifier: HO-19-19749) Disclosures Parinaz Ghaswalla, PhD, ORCID: 0000-0002-2883-5590, GlaxoSmithKline (Employee, Shareholder) Philippe Thompson-Leduc, MSc, ORCID: 0000-0001-9047-3941, Analysis Group, Inc. (Employee) Wendy Y. Cheng, MPH, PhD, ORCID: 0000-0002-8281-2496, GlaxoSmithKline (Other Financial or Material Support, I am an employee of Analysis Group, a consulting company that received research fund to conduct this study.) Min-Jung Wang, ScD, ORCID: 0000-0003-4432-3330, Analysis Group, Inc. (Employee, Other Financial or Material Support, Analysis Group received grant/research support from GSK) Michael Bogart, PharmD, ORCID: 0000-0002-1681-9710, GlaxoSmithKline (Employee, Shareholder) Brandon J. Patterson, PharmD, PhD, GSK (Employee, Shareholder) Mei-Sheng Duh, MPH, ScD, ORCID: 0000-0001-5035-6687, GlaxoSmithKline (Grant/Research Support) Suna Park, MS, GSK (Other Financial or Material Support, Analysis Group, Inc., where I am an employee, received funding for this study) Barbara P. Yawn, MD, Msc, ORCID: 0000-0001-7278-5810, GSK (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member)

scholarly journals Comparative Risk of Incidence and Clinical Outcomes of COVID-19 among Proton Pump Inhibitor and Histamine-2 Receptor Antagonist Users: A Nationwide Retrospective Cohort Study

2021 ◽  
Author(s):  
Jimyung Park ◽  
Seng Chan You ◽  
Jaehyeong Cho ◽  
Chan Hyuk Park ◽  
Woon Shin ◽  
...  
Keyword(s):  
Cohort Study ◽  
South Korea ◽  
Receptor Antagonist ◽  
Clinical Outcomes ◽  
Respiratory Disease ◽  
Proton Pump ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Large Scale ◽  
All Cause Mortality

Abstract Background: This study aimed to evaluate incidence risk and severe clinical outcomes in COVID-19 disease among short-term users of acid-suppressants in South Korea.Methods: This retrospective cohort study, conducted using a nationwide claims database for South Korea, used data from patients with COVID-19 tested between January 1 and May 15, 2020. Patients aged over 18 years and prescribed proton pump inhibitors (PPI) or histamine-2 receptor antagonist (H2RA) for more than 7 days were identified. Primary outcome was COVID-19 while secondary outcomes were all-cause mortality, hospitalization with respiratory disease, or intensive respiratory intervention. Large-scale propensity scores were used to match patients, while the Cox proportional hazard model was utilized to evaluate any association between exposure and outcome(s). The risk estimates were calibrated by using 123 falsification endpoints.Results: We identified 26,166 PPI users and 62,117 H2RA users. After propensity score matching, compared to H2RA use, PPI use was not significantly associated with lower risk of COVID-19 (calibrated hazard ratio [HR], 0.81 [95% confidence interval (CI), 0.30–2.19]); moreover, PPI use was not associated with adverse clinical outcomes in COVID-19, namely, hospitalization with respiratory disease (calibrated HR, 0.88 [95% CI, 0.72–1.08]), intensive respiratory interventions (calibrated HR, 0.92 [95% CI, 0.46–1.82]), except for all-cause mortality (calibrated HR, 0.54 [95% CI, 0.31–0.95]).Conclusions: In this study, we found that the PPI user was not associated with risk of COVID-19 compared to H2RA users. There was no significant relationship between severe clinical outcomes of COVID-19 and exposure to PPI compared with H2RA, except for all-cause mortality.

Sign in / Sign up

Export Citation Format

Share Document