scholarly journals Risk Factors for Carbapenem Resistance in Gram Negative Nosocomial Pneumonia: A Single Centre Prospective Cohort Study

2021 ◽  
Author(s):  
Swayambhu Banerjee ◽  
Renoy Henry ◽  
Sandeep Surendran ◽  
Abhiram Pillai ◽  
Rema Pai
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Nosocomial Pneumonia ◽  
Prospective Cohort ◽  
Tertiary Care ◽  
Antibiotic Sensitivity ◽  
Tertiary Care Centre ◽  
Gram Negative ◽  
Stewardship Program

Introduction: Gram Negative Bacilli (GNB) account for about 70% of Hospital Acquired Pneumonia (HAP), Ventilator Acquired Pneumonia (VAP) and Healthcare Associated Pneumonia (HCAP). Increasing use of carbapenems lead to infections caused by GNBs with therapeutically challenging Extended-Spectrum Beta-Lactamases (ESBLs). Aim: To assess the risk factors and clinical outcomes associated with HAP, VAP and HCAP caused by Carbapenem Resistant (CR) GNB at a Tertiary Care Centre. Materials and Methods: The present study was a prospective cohort study which was conducted from February 2015 to September 2016 that included 66 patients with Broncho Alveolar Lavage (BAL) cultures for GNB. Clinical, demographic and microbiological data (including antibiotic sensitivity) along with overall mortality, occurrence of sepsis and length of stay were collected for each patient. Data were analysed using OpenStat 30.0 along with relevant descriptive statistics. Comparison of outcomes between CR and Carbapenem Sensitive (CS) group were studied along with the concordance between initial antibiotics and BAL culture sensitivity. Results: Overall prevalence of CR in the cohort was 54.54%. The most common organism to be ESBL positive was Klebsiella pneumoniae (45.45%). Exposure to previous antibiotics was a risk factor for CR (p=0.017). Mortality was higher (50%) in CR group than in CS group (23.3%; p=0.026). There were 45.8% of the cases having lack of concordance of initial antibiotics that died in comparison to 16.7% who had an appropriate initial antibiotic therapy (p=0.030). Conclusion: There is a high prevalence of CR in nosocomial pneumonia. Judicious use of antibiotics is the need of the hour and can be implemented by an Antibiotic Stewardship program.

scholarly journals Normal renal sonogram identifies renal colic patients at low risk for urologic intervention: a prospective cohort study

CJEM ◽  
2015 ◽  
Vol 17 (1) ◽  
pp. 38-45 ◽  
Author(s):  
Justin W. Yan ◽  
Shelley L. McLeod ◽  
Marcia L. Edmonds ◽  
Robert J. Sedran ◽  
Karl D. Theakston
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Medical Records ◽  
Prospective Cohort ◽  
Renal Colic ◽  
Tertiary Care ◽  
Low Risk ◽  
Ureteric Stone ◽  
Tertiary Care Centre ◽  
Imaging Department

AbstractIntroductionDetermining which patients with ureterolithiasis are likely to require urologic intervention is a common challenge in the emergency department (ED). The objective was to determine if normal renal sonogram could identify low-risk renal colic patients, who were defined as not requiring urologic intervention within 90 days of their initial ED visit and can be managed conservatively.MethodsThis was a prospective cohort study involving adult patients presenting to the EDs of a tertiary care centre with suspected renal colic over a 20-month period. Renal ultrasonography (US) was performed in the diagnostic imaging department by trained ultrasonographers, and the results were categorized into four mutually exclusive groups: normal, suggestive of ureterolithiasis, visualized ureteric stone, or findings unrelated to urolithiasis. Electronic medical records were reviewed to determine if patients received urologic intervention within 90 days of their ED visit.ResultsOf 610 patients enrolled, 341 (55.9%) had US for suspected renal colic. Of those, 105 (30.8%) were classified as normal; none of these patients underwent urologic intervention within 90 days of their ED visit. Ninety (26.4%) US results were classified as suggestive, and nine (10%) patients received urologic intervention. A total of 139 (40.8%) US results were classified as visualized ureteric stone, and 34 (24.5%) patients had urologic intervention. Seven (2.1%) US results were classified as findings unrelated to urolithiasis, and none of these patients required urologic intervention. The rate of urologic intervention was significantly lower in those with normal US results (p<0.001) than in those with abnormal findings.ConclusionA normal renal sonogram predicts a low likelihood for urologic intervention within 90 days for adult ED patients with suspected renal colic.

scholarly journals Post-COVID-19 syndrome among symptomatic COVID-19 patients: A prospective cohort study in a tertiary care center of Bangladesh

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249644
Author(s):  
Reaz Mahmud ◽  
Md. Mujibur Rahman ◽  
Mohammad Aftab Rassel ◽  
Farhana Binte Monayem ◽  
S. K. Jakaria Been Sayeed ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Respiratory Distress ◽  
Clinical Improvement ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Tertiary Care ◽  
World Health ◽  
Female Sex ◽  
Oxygen Inhalation

Background Post-coronavirus disease (COVID-19) syndrome includes persistence of symptoms beyond viral clearance and fresh development of symptoms or exaggeration of chronic diseases within a month after initial clinical and virological cure of the disease with a viral etiology. We aimed to determine the incidence, association, and risk factors associated with development of the post-COVID-19 syndrome. Methods We conducted a prospective cohort study at Dhaka Medical College Hospital between June 01, 2020 and August 10, 2020. All the enrolled patients were followed up for a month after clinical improvement, which was defined according the World Health Organization and Bangladesh guidelines as normal body temperature for successive 3 days, significant improvement in respiratory symptoms (respiratory rate <25/breath/minute with no dyspnea), and oxygen saturation >93% without assisted oxygen inhalation. Findings Among the 400 recruited patients, 355 patients were analyzed. In total, 46% patients developed post-COVID-19 symptoms, with post-viral fatigue being the most prevalent symptom in 70% cases. The post-COVID-19 syndrome was associated with female gender (relative risk [RR]: 1.2, 95% confidence interval [CI]: 1.02–1.48, p = 0.03), those who required a prolonged time for clinical improvement (p<0.001), and those showing COVID-19 positivity after 14 days (RR: 1.09, 95% CI: 1.00–1.19, p<0.001) of initial positivity. Patients with severe COVID-19 at presentation developed post-COVID-19 syndrome (p = 0.02). Patients with fever (RR: 1.5, 95% CI: 1.05–2.27, p = 0.03), cough (RR: 1.36, 95% CI: 1.02–1.81, p = 0.04), respiratory distress (RR: 1.3, 95% CI: 1.4–1.56, p = 0.001), and lethargy (RR: 1.2, 95% CI: 1.06–1.35, p = 0.003) as the presenting features were associated with the development of the more susceptible to develop post COVID-19 syndrome than the others. Logistic regression analysis revealed female sex, respiratory distress, lethargy, and long duration of the disease as risk factors. Conclusion Female sex, respiratory distress, lethargy, and long disease duration are critical risk factors for the development of post-COVID-19 syndrome.

scholarly journals Risk factors for functional decline among survivors of Gram-negative bloodstream infection: A prospective cohort study

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259707
Author(s):  
Adi Turjeman ◽  
Fidi Koppel ◽  
Erica Franceschini ◽  
Dafna Yahav ◽  
Giovanni Dolci ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Functional Dependence ◽  
Controlled Trial ◽  
Functional Decline ◽  
Multivariable Analysis ◽  
Gram Negative ◽  
Gram Negative Bacteremia

Objective To identify risk factors for functional decline after hospitalization for Gram-negative bacteremia. Patients and methods A prospective cohort study based on a randomized controlled trial conducted between January 1, 2013 and August 31, 2017 in Israel and Italy. Hospitalized patients with Gram-negative bacteremia who survived until day 90 and were not bedridden at baseline were included. The primary end point was functional decline at 90 days. Results Five hundred and nine patients were included. The median age of the cohort was 71 years (interquartile range [IQR], 60–80 years), 46.4% (236/509) were male and 352 of 509 (69%) patients were independent at baseline. Functional decline at 90 days occurred in 24.4% of patients (124/509). In multivariable analysis; older age (odds ratio [OR], 1.03; for an one-year increment, 95% confidence interval [CI] 1.01–1.05), functional dependence in instrumental activities of daily living at baseline (OR, 4.64; 95% CI 2.5–8.6), low Norton score (OR, 0.87; 95% CI 0.79–0.96) and underlying comorbidities: cancer (OR, 2.01; 95% CI 1.14–3.55) and chronic pulmonary disease (OR, 2.23 95% CI 1.12–4.42) and longer length of hospital stay (OR 1.09; for one-day increment, 95% CI 1.04–1.15) were associated with functional decline. Appropriate empirical antibiotic treatment was associated with lower rates of functional decline within 90 days (OR, 0.4; 95% CI 0.21–0.78). Conclusions Patients surviving bloodstream infections have poor long term trajectories after clinical recovery and hospital discharge. This has vast implications for patients, their family members and health policy makers.

The Natural Course and Risk Factors for Progression of Diabetic Retinopathy-KNDP Prospective Cohort Study

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1571-P
Author(s):  
HYUN UK MOON ◽  
JA YOUNG JEON ◽  
SOOJIN LEE ◽  
SEUNG JIN HAN ◽  
HAE JIN KIM ◽  
...  
Keyword(s):  
Risk Factors ◽  
Diabetic Retinopathy ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Natural Course
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