scholarly journals Clinical Factors Associated with a Shorter or Longer Course of Antibiotic Treatment in Patients with Exacerbations of Bronchiectasis: A Prospective Cohort Study

2019 ◽  
Vol 8 (11) ◽  
pp. 1950
Author(s):  
Giulia Scioscia ◽  
Rosanel Amaro ◽  
Victoria Alcaraz-Serrano ◽  
Albert Gabarrús ◽  
Patricia Oscanoa ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Treatment ◽  
Prospective Observational Study ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Clinical Factors ◽  
Treatment Results ◽  
Factors Associated ◽  
Long Term Oxygen Therapy

Background: Bronchiectasis exacerbations are often treated with prolonged antibiotic use, even though there is limited evidence for this approach. We therefore aimed to investigate the baseline clinical and microbiological findings associated with long courses of antibiotic treatment in exacerbated bronchiectasis patients. Methods: This was a bi-centric prospective observational study of bronchiectasis exacerbated adults. We compared groups receiving short (≤14 days) and long (15–21 days) courses of antibiotic treatment. Results: We enrolled 191 patients (mean age 72 (63, 79) years; 108 (56.5%) females), of whom 132 (69%) and 59 (31%) received short and long courses of antibiotics, respectively. Multivariable logistic regression of the baseline variables showed that long-term oxygen therapy (LTOT), moderate–severe exacerbations, and microbiological isolation of Pseudomonas aeruginosa were associated with long courses of antibiotic therapy. When we excluded patients with a diagnosis of community-acquired pneumonia (n = 49), in the model we found that an etiology of P. aeruginosa remained as factor associated with longer antibiotic treatment, with a moderate and a severe FACED score and the presence of arrhythmia as comorbidity at baseline. Conclusions: Decisions about the duration of antibiotic therapy should be guided by clinical and microbiological assessments of patients with infective exacerbations.

scholarly journals Antibiotic Prescribing for Adults Hospitalized in the Etiology of Pneumonia in the Community Study

2017 ◽  
Vol 4 (2) ◽  
Author(s):  
Sara Tomczyk ◽  
Seema Jain ◽  
Anna M Bramley ◽  
Wesley H Self ◽  
Evan J Anderson ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Community Study ◽  
Antibiotic Prescribing ◽  
Beta Lactam ◽  
First Line ◽  
Factors Associated ◽  
Admission Ward ◽  
Healthcare Associated ◽  
To Receive

Abstract Background Community-acquired pneumonia (CAP) 2007 guidelines from the Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) recommend a respiratory fluoroquinolone or beta-lactam plus macrolide as first-line antibiotics for adults hospitalized with CAP. Few studies have assessed guideline-concordant antibiotic use for patients hospitalized with CAP after the 2007 IDSA/ATS guidelines. We examine antibiotics prescribed and associated factors in adults hospitalized with CAP. Methods From January 2010 to June 2012, adults hospitalized with clinical and radiographic CAP were enrolled in a prospective Etiology of Pneumonia in the Community study across 5 US hospitals. Patients were interviewed using a standardized questionnaire, and medical charts were reviewed. Antibiotics prescribed were classified according to defined nonrecommended CAP antibiotics. We assessed factors associated with nonrecommended CAP antibiotics using logistic regression. Results Among enrollees, 1843 of 1874 (98%) ward and 440 of 446 (99%) ICU patients received ≥1 antibiotic ≤24 hours after admission. Ward patients were prescribed a respiratory fluoroquinolone alone (n = 613; 33%), or beta-lactam plus macrolide (n = 365; 19%), beta-lactam alone (n = 240; 13%), among other antibiotics, including vancomycin (n = 235; 13%) or piperacillin/tazobactam (n = 157; 8%) ≤24 hours after admission. Ward patients with known risk for healthcare-associated pneumonia (HCAP), recent outpatient antibiotic use, and in-hospital antibiotic use <6 hours after admission were significantly more likely to receive nonrecommended CAP antibiotics. Conclusions Although more than half of ward patients received antibiotics concordant with IDSA/ATS guidelines, a number received nonrecommended CAP antibiotics, including vancomycin and piperacillin/tazobactam; risk factors for HCAP, recent outpatient antibiotic, and rapid inpatient antibiotic use contributed to this. This hypothesis-generating descriptive epidemiology analysis could help inform antibiotic stewardship efforts, reinforces the need to harmonize guidelines for CAP and HCAP, and highlights the need for improved diagnostics to better equip clinicians.

scholarly journals Factors Associated with Treatment Failure in Patients with Acute Exacerbation of COPD Admitted to the Emergency Department Observation Unit

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Wasuntaraporn Pethyabarn ◽  
Sareeman Chewae ◽  
Ar-aishah Dadeh
Keyword(s):  
Treatment Failure ◽  
Beta Agonist ◽  
Diabetic Mellitus ◽  
Observation Unit ◽  
X Ray ◽  
Factors Associated ◽  
Chest X Ray ◽  
Exacerbation Of Copd ◽  
Long Term Oxygen Therapy

Objective. We aimed to identify factors associated with treatment failure in patients with acute exacerbation of COPD (AECOPD) admitted to the emergency department observation unit (EDOU). Methods. A retrospective cohort study was conducted between January 1, 2013, and October 31, 2019. The electronic medical records were reviewed of patients with AECOPD admitted to the EDOU. The patients were divided into treatment failure and treatment success groups. Treatment failure was defined as prolonged stay at the EDOU (>48 h) or COPD-related ED revisit (within 72 h) or readmission within 1 month. The two groups were compared and analyzed using univariable and multivariable analyses by logistic regression. Results. Of the 220 patients enrolled, 82 (37.3%) developed treatment failure. Factors associated with treatment failure included arrhythmias (odds ratio [OR] 3.8, 95% confidence interval [CI] 1.04–13.9), diabetic mellitus (OR 2.32, 95% CI 1.09–4.95), long-term oxygen therapy (OR 2.89, 95% CI 1.08–7.72), short-acting beta-agonist use (OR 6.06, 95% CI 1.98–18.62), pneumonia findings on chest X-ray (OR 3.24, 95% CI 1.06–9.95), and ED length of stay less than 4 h (OR 2, 95% CI 1.08–3.73). Conclusion. Arrhythmias, diabetic mellitus, long-term oxygen therapy, short-acting beta-agonist use, pneumonia findings on chest X-ray, and ED length of stay <4 h were the significant factors associated with treatment failure of AECOPD to which physicians at the ED should pay special attention before the admission of patients to the EDOU.

scholarly journals Long-term follow-up of the use of maintenance antibiotic therapy for chronic antibiotic-dependent pouchitis

2018 ◽  
Vol 9 (2) ◽  
pp. 154-158 ◽  
Author(s):  
Jonathan P Segal ◽  
Stephanie X Poo ◽  
Simon D McLaughlin ◽  
Omar D Faiz ◽  
Susan K Clark ◽  
...  
Keyword(s):  
Side Effects ◽  
Antibiotic Therapy ◽  
Antibiotic Use ◽  
Safety And Efficacy ◽  
Pouch Failure ◽  
Patient Reported ◽  
Long Term Follow Up ◽  
Term Maintenance

ObjectiveRestorative proctolectomy is considered the procedure of choice in patients with ulcerative colitis who have failed medical therapy. Chronic pouchitis occurs in 10%–15% of patients, which often require long-term antibiotics to alleviate symptoms. Safety and efficacy of long-term maintenance antibiotics for chronic pouchitis has yet to be established. We aimed to assess the long-term safety and efficacy of maintenance antibiotic therapy for chronic pouchitis.DesignThis was an observational study. We followed up patients who were diagnosed with chronic antibiotic-dependent pouchitis.SettingData were collected from our single specialist pouch centre.PatientsPatients with chronic antibiotic-dependent pouchitis who had been maintained on antibiotics continuously for at least 1 year with a least one follow-up visit.Main outcome measureDevelopment of pouch failure defined by the need for an ileostomy, patient-reported side effects of antibiotics and development of antibiotic resistance found on stool coliform testing.ResultsLong-term use of antibiotics achieve remission in 21% of patients over a median follow-up of 102 (range 9–125). Pouch failure in association with chronic pouchitis after a median follow-up of 8.5 years occurred in 18%. Side effects of long-term antibiotic use occurred in 28% of patients, with resistance to antibiotics from at least one stool sample occurring in 78% patients.ConclusionsAlthough the use of antibiotics in chronic pouchitis may be justified, the use of long-term antibiotics must be weighed against potential complications associated with pouchitis and antibiotics.

Long-term Antibiotic Treatment in Pouchitis—Patterns of Use and Safety

2021 ◽  
Author(s):  
Nir Bar ◽  
Yoav Avraham ◽  
Vadim Dubinsky ◽  
Nathaniel A Cohen ◽  
Guy A Weiss ◽  
...  
Keyword(s):  
Adverse Events ◽  
Antibiotic Treatment ◽  
Antibiotic Use ◽  
Control Analysis ◽  
Patterns Of Use ◽  
Antibiotics Use ◽  
Case Control Analysis ◽  
Favorable Safety ◽  
Nested Case Control

Abstract Introduction Pouchitis, often developing after colectomy and ileal pouch-anal anastomosis for ulcerative colitis, is highly responsive to antibiotics. Ciprofloxacin and/or metronidazole are commonly used, often for prolonged periods. We report patterns of antibiotic use, adverse events, and resistant infections in patients with pouchitis with long-term antibiotic treatment. Methods In a cohort of patients following pouch surgery, a retrospective nested case-control analysis was performed between 2010 and 2017. Ultra-long-term use, defined as the top 10% of users, was compared with the remaining users. Patterns of antibiotic use, adverse events, and resistant infections were analyzed. Results The cohort included 205 patients with UC, of whom 167 (81.5%) used antibiotics for pouchitis, predominantly ciprofloxacin. The long-term antibiotic use rate was 18% and 42% at 5 and 20 years postsurgery, respectively. Mean antibiotic use of at least 1, 3, and 6 months/year was noted in 54 (26.3%), 31 (15.1%), and 14 (6.8%) patients, respectively. Twenty-two (13.2%) and 4 (2.4%) patients reported mild and severe (transient) adverse events, respectively, without mortalities, tendinopathies or arrhythmias. Adverse event rates for ciprofloxacin and metronidazole were 1per 10,000 and 6 per 10,000 use-days, respectively. Longer, but not ultra-long antibiotic use, was associated with mild adverse events. There was no association between antibiotic use and resistant infections. Thirteen (6.3%) patients required ileostomy procedures—more commonly in the ultra-long-term antibiotic users. Conclusions Patients with pouchitis may require prolonged antibiotic treatment, reflecting clinical benefit and favorable safety profile. Few adverse events and resistant infections were observed with long-term antibiotics use. However, resistant microbial strains selection, which are potentially transmittable, warrants consideration of different therapeutic alternatives.

Purple urine bag syndrome: When the urine turns purple – An under diagnosed spot diagnosis

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Cathrin Kodde ◽  
◽  
Till Othmer ◽  
David Krieger ◽  
Silke Polsfuss ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Antibiotic Therapy ◽  
Urinary Catheter ◽  
Rare Condition ◽  
Community Acquired Pneumonia ◽  
Purple Urine Bag Syndrome ◽  
Indigo Blue ◽  
Tract Infections ◽  
Purple Urine

The Purple Urine Bag Syndrome (PUBS) is a rare condition in which the urine turns purple. It may occur in Urinary Tract Infections (UTIs) when bacteria metabolize dietary tryptophan to indole resulting in indigo (blue) and indirubin (red). This condition is mostly seen in elderly female patients with permanent urinary bladder catheterization. Patients, relatives and health professionals may be concerned about this discolouration, which is usually harmless. Medical management of PUBS involves frequent urinary bag change, antibiotic therapy and most importantly reassurance. We report an 89-years-old long-term catheterized female nursing home resident who was admitted to the emergency room because of a Community Acquired Pneumonia (CAP). After a few days of inpatient treatment her urine bag turned purple. Antibiotic therapy continued and the indwelling urinary catheter was changed resulting in clear urine. Keywords: Purple urine bag syndrome (PUBS); purple discolouration; urinary tract infection (UTI); long-term catheterization.

scholarly journals Clinical, epidemiological, and etiological profile of inpatients with community-acquired pneumonia in a public hospital in the interior of Brazil

2018 ◽  
Vol 44 (4) ◽  
pp. 261-266 ◽  
Author(s):  
Laura Fuchs Bahlis ◽  
Luciano Passamani Diogo ◽  
Ricardo de Souza Kuchenbecker ◽  
Sandra Costa Fuchs
Keyword(s):  
Mechanical Ventilation ◽  
Multivariate Analysis ◽  
Mortality Rate ◽  
Hospital Mortality ◽  
Antibiotic Therapy ◽  
Public Hospital ◽  
Community Acquired Pneumonia ◽  
Factors Associated ◽  
Icu Admission ◽  
Patient Profile

ABSTRACT Objective: To describe the patient profile, mortality rates, the accuracy of prognostic scores, and mortality-associated factors in patients with community-acquired pneumonia (CAP) in a general hospital in Brazil. Methods: This was a cohort study involving patients with a clinical and laboratory diagnosis of CAP and requiring admission to a public hospital in the interior of Brazil between March 2014 and April 2015. We performed multivariate analysis using a Poisson regression model with robust variance to identify factors associated with in-hospital mortality. Results: We included 304 patients. Approximately 70% of the patients were classified as severely ill on the basis of the severity criteria used. The mortality rate was 15.5%, and the ICU admission rate was 29.3%. After multivariate analysis, the factors associated with in-hospital mortality were need for mechanical ventilation (OR: 3.60; 95% CI: 1.85-7.47); a Charlson Comorbidity Index score > 3 (OR: 1.30; 95% CI: 1.18-1.43); and a mental Confusion, Urea, Respiratory rate, Blood pressure, and age > 65 years (CURB-65) score > 2 (OR: 1.46; 95% CI: 1.09-1.98). The mean time from patient arrival at the emergency room to initiation of antibiotic therapy was 10 h. Conclusions: The in-hospital mortality rate of 15.5% and the need for ICU admission in almost one third of the patients reflect the major impact of CAP on patients and the health care system. Individuals with a high burden of comorbidities, a high CURB-65 score, and a need for mechanical ventilation had a worse prognosis. Measures to reduce the time to initiation of antibiotic therapy may result in better outcomes in this group of patients.

scholarly journals Tuberculosis among individuals with community-acquired pneumonia presenting to emergency in Gaborone, Botswana

2018 ◽  
Author(s):  
Jill K. Gersh ◽  
Zachary Feldman ◽  
Emily Greenberger ◽  
Amit Chandra ◽  
Harvey M. Friedman ◽  
...  
Keyword(s):  
Emergency Department ◽  
Retrospective Study ◽  
Community Acquired Pneumonia ◽  
Clinical Syndrome ◽  
Hiv Positive ◽  
Sputum Smear ◽  
Clinical Factors ◽  
Pulmonary Tb ◽  
Factors Associated ◽  
Logistic Regressions

Delays in diagnosing Tuberculosis (TB) are associated with increased transmission. TB may present as a clinical syndrome that mimics community-acquired pneumonia (CAP). The aim of this paper was to determine frequency of TB among patients with CAP at a referral hospital in Gaborone, Botswana. We performed a retrospective study of adults presenting with CAP from April 2010-October 2011 to the Emergency Department (ED); we matched this cohort to the National Botswana Tuberculosis Registry (NBTR) to identify individuals subsequently diagnosed with TB. We assessed demographics, time to TB diagnosis, clinical outcomes and performed logistic regressions to identify factors associated with TB diagnosis. We identified 1305 individuals presenting with CAP; TB was subsequently diagnosed in 68 (5.2%). The median time to TB diagnosis was 9.5 days. Forty percent were AFB sputum smear positive and 87% were identified as being HIV-positive. Subsequent diagnosis of TB is common among individuals with CAP at our ED, suggesting that TB may be present at the time of CAP presentation. Given the lack of distinguishing clinical factors between pulmonary TB and CAP, adults presenting with CAP should be evaluated for active TB in Botswana.

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