Evaluating Vancomycin Use at a Pediatric Hospital: New Approaches and Insights

2005 ◽  
Vol 26 (1) ◽  
pp. 47-55 ◽  
Author(s):  
Maureen K. Bolon ◽  
Alana D. Arnold ◽  
Henry A. Feldman ◽  
David H. Rehkopf ◽  
Emily F. Strong ◽  
...  
Keyword(s):  
Risk Factors ◽  
Factor Analysis ◽  
Risk Factor ◽  
Tertiary Care ◽  
Significant Risk ◽  
Risk Factor Analysis ◽  
Cell Transplant ◽  
Care Hospital ◽  
Inappropriate Use ◽  
Tertiary Care Medical Center

AbstractObjectives:To characterize vancomycin use at a pediatric tertiary-care hospital, to discriminate between initial (≤ 72 hours) and prolonged (> 72 hours) inappropriate use, and to define patient characteristics associated with inappropriate use.Design:Vancomycin courses were retrospectively reviewed using an algorithm modeled on HICPAC guidelines. Data were collected regarding patient demographics, comorbidities, other medication use, and nosocomial infections. The association between each variable and the outcome of inappropriate use was determined by longitudinal regression analysis. A multi-variable model was constructed to assess risk factors for inappropriate initial and prolonged vancomycin use.Setting:A pediatric tertiary-care medical center.Patients:Children older than 1 year who received intravenous vancomycin from November 2000 to June 2001.Results:Three hundred twenty-seven vancomycin courses administered to 260 patients were evaluated for appropriateness. Of initial courses, 114 (35%) were considered inappropriate. Of 143 prolonged courses, 103 (72%) were considered inappropriate. Multivariable risk factor analysis identified the following variables as significantly associated with inappropriate initial use: admission to the surgery service, having a malignancy, receipt of a stem cell transplant, and having received a prior inappropriate course of vancomycin. No variables were identified as significant risk factors for inappropriate prolonged use.Conclusions:Substantial inappropriate use of vancomycin was identified. Prolonged inappropriate use was a particular problem. This risk factor analysis suggests that interventions targeting patients admitted to certain services or receiving multiple courses of vancomycin could reduce inappropriate use.

Pediatric herniated lumbar disc: a population-based risk factor analysis

2020 ◽  
Vol 25 (3) ◽  
pp. 311-318
Author(s):  
Jacob R. Lepard ◽  
Kathrin D. Zimmerman ◽  
Anastasia A. Arynchyna ◽  
Jessica A. Gutman ◽  
Arsalaan A. Salehani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Factor Analysis ◽  
Risk Factor ◽  
Surgical Treatment ◽  
Disease Risk ◽  
Lumbar Disc ◽  
Tertiary Care ◽  
Sports Participation ◽  
Risk Factor Analysis ◽  
Herniated Lumbar Disc

OBJECTIVESurgical treatment of herniated lumbar disc (HLD) remains rare in children. The purpose of this study was to evaluate for potential disease risk factors leading to surgery based on a large single-center experience.METHODSData for all patients who had undergone surgical treatment for HLD between December 2008 and December 2016 at a single pediatric tertiary care referral center were collected and compared to data for a healthy control population obtained through a Youth Risk Behavior Surveillance System (YRBSS) survey in order to determine relevant disease risk factors. Univariate and multivariate logistic regression were used to determine the effect of potential risk factors.RESULTSTwenty-seven patients in the disease cohort and 5212 healthy controls from the general population were included in the risk factor analysis. The mean body mass index was significantly higher in the disease population (30.2 vs 24.0 kg/m2, p < 0.0001). Children who had undergone microdiscectomy were more likely to be obese (OR 7.4, 95% CI 3.46–15.8, p < 0.001). No association was found between lumbar microdiscectomy and sports participation (OR 1.0, 95% CI −0.002 to 0.005, p = 0.37).CONCLUSIONSMicrodiscectomy remains a viable and safe option in the setting of failed conservative management for pediatric HLD. Childhood obesity is a risk factor for HLD and many other diseases, which increases its importance as a public health priority.

Feline diabetes mellitus in the UK: The prevalence within an insured cat population and a questionnaire-based putative risk factor analysis

2007 ◽  
Vol 9 (4) ◽  
pp. 289-299 ◽  
Author(s):  
Theresa M McCann ◽  
Kerry E Simpson ◽  
Darren J Shaw ◽  
Jennifer A Butt ◽  
Danielle A. Gunn-Moore
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Factor Analysis ◽  
Risk Factor ◽  
Classification Tree ◽  
Significant Risk ◽  
Corticosteroid Treatment ◽  
Risk Factor Analysis ◽  
Increased Risk ◽  
The Uk

Prevalence and risk factors for the development of diabetes mellitus (DM) in cats in the United Kingdom have not previously been reported. The prevalence of DM was evaluated in a large insured population and was found to be 1 in 230 cats. In this insured cat population Burmese cats were 3.7 times more likely to develop DM than non-pedigree cats. A convenience-sampling questionnaire-based study was used in order to identify putative risk factors for the development of DM. The univariate risk factor analysis identified being male, neutered, inactive, weighing ≥5 kg and having a history of corticosteroid treatment as significant risk factors for the development of DM in these cats. In addition, male cats treated with megestrol acetate had a significantly increased risk of developing DM compared to females. In contrast, there was no difference in DM occurrence between male and female Burmese cats. A multivariate classification tree-based model on the questionnaire data looking for interactions between risk factors, identified gender as the most important overall risk factor for the development of DM with low physical activity being the next most important risk factor for female cats and breed the next most important for male cats.

scholarly journals Sex differences in clinical presentation in acute MI

2017 ◽  
Vol 4 (4) ◽  
pp. 940
Author(s):  
Ashwin Kodliwadmath ◽  
Naren V. Nimbal
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Chest Pain ◽  
Clinical Presentation ◽  
Tertiary Care ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Control Group ◽  
Care Hospital ◽  
Acute Mi

Background: Acute myocardial infarction differs in women and men with respect to risk factors and clinical presentation. There are studies carried out worldwide on this issue but few from India. This study was done to study the sex based differences in the risk factors and clinical features of acute MI in patients with Indian ethnicity.Methods: Comparative prospective study consisting of 100 women as study group and 100 men as control group with acute MI, who were admitted in a tertiary care hospital, from December 2016 to June 2017.Results: Chest pain was the main complaint in majority of the women (82%) and men (88%). Radiation of chest pain (87%) and sweating (90%) were significantly present in men compared to women (65% and 62% respectively), while breathlessness was significantly present in women (78%) compared to men (64%) and fatigue in women (76%) significantly more than men (55%). Smoking was a significant risk factor in men (69%) compared to women (5%), while diabetes mellitus was a significant risk factor in women (62%) compared to men (39%).Conclusions: Women with acute MI had more atypical presentation of symptoms, similar risk factors, compared to men except for smoking which was more significant in men and diabetes more common in women.

scholarly journals Risk factor analysis among patients with stroke: a cross sectional study at a tertiary care hospital

2018 ◽  
Vol 5 (4) ◽  
pp. 1036
Author(s):  
Rajiv Kumar B. ◽  
U. Kishan ◽  
Arun Kumar N.
Keyword(s):  
Factor Analysis ◽  
Risk Factor ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Cross Sectional Study ◽  
Favourable Outcome ◽  
Risk Factor Analysis ◽  
Care Hospital ◽  
Age Group ◽  
Cross Sectional

Background: Study of risk factors of stroke is very important in different settings to confirm their existence and to take necessary steps to prevent them especially in elderly so that incidence of stroke can be brought down. The objective of the present study is to perform the risk factor analysis among patients with stroke.Methods: A hospital based cross sectional study was carried out at a tertiary care hospital from June 2015 to March 2016. A total of 40 patients diagnosed with stroke were included in the present study. Detailed information and all necessary investigations were carried out. Risk factor analysis was done, and categorization was done for certain risk factors.Results: The predominant age group was 6-60 years. The age ranged from 1 month to 67 years. The Male: Female ratio was 14:9. The common etiologies were congenital, post infective and intracranial bleed in 26.1% (n=6) each. Favourable outcome was seen in 82.6% of cases. The failure rate was 17.4%. Most no of cases with favourable outcome was seen in 6-60 years age group, whereas >60 years age group had the most no of cases with poor outcome. The overall mortality rate was 21.6% (n=5). Wound related complication was seen in 1 patient (4.3%).  Two (8.7%) patients required VP shunt post ETV. The cause of mortality was aspiration pneumonitis in 3 cases, CSF metastasis and wound infection in 1 cases each.Conclusions: The leading cause as well as risk factor for stroke was found to be hypertension followed by alcohol and smoking.

Evaluation of Hospital Room Assignment and Acquisition of Clostridium difficile Infection

2011 ◽  
Vol 32 (3) ◽  
pp. 201-206 ◽  
Author(s):  
Megan K. Shaughnessy ◽  
Renee L. Micielli ◽  
Daryl D. DePestel ◽  
Jennifer Arndt ◽  
Cathy L. Strachan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Clostridium Difficile ◽  
Tertiary Care ◽  
Significant Risk ◽  
Extended Period ◽  
Significant Risk Factor ◽  
Antibiotic Use ◽  
Care Hospital ◽  
Icu Discharge

Background and Objective.Clostridium difficile spores persist in hospital environments for an extended period. We evaluated whether admission to a room previously occupied by a patient with C. difficile infection (CDI) increased the risk of acquiring CDI.Design.Retrospective cohort study.Setting.Medical intensive care unit (ICU) at a tertiary care hospital.Methods.Patients admitted from January 1, 2005, through June 30, 2006, were evaluated for a diagnosis of CDI 48 hours after ICU admission and within 30 days after ICU discharge. Medical, ICU, and pharmacy records were reviewed for other CDI risk factors. Admitted patients who did develop CDI were compared with admitted patients who did not.Results.Among 1,844 patients admitted to the ICU, 134 CDI cases were identified. After exclusions, 1,770 admitted patients remained for analysis. Of the patients who acquired CDI after admission to the ICU, 4.6% had a prior occupant without CDI, whereas 11.0% had a prior occupant with CDI (P = .002). The effect of room on CDI acquisition remained a significant risk factor (P = .008) when Kaplan-Meier curves were used. The prior occupant's CDI status remained significant (P = .01; hazard ratio, 2.35) when controlling for the current patient's age, Acute Physiology and Chronic Health Evaluation III score, exposure to proton pump inhibitors, and antibiotic use.Conclusions.A prior room occupant with CDI is a significant risk factor for CDI acquisition, independent of established CDI risk factors. These findings have implications for room placement and hospital design.

scholarly journals Vancomycin-resistance Enterococcal Colonization in Hospitalized Patients in Relation to Antibiotic Usage in a Tertiary Care Hospital of North India

2015 ◽  
Vol 7 (02) ◽  
pp. 108-111 ◽  
Author(s):  
Tuhina Banerjee ◽  
Shampa Anupurba ◽  
Joel Filgona ◽  
Dinesh K Singh
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Tertiary Care ◽  
Significant Risk ◽  
Antibiotic Use ◽  
Antibiotic Usage ◽  
Hospitalized Patients ◽  
University Hospital ◽  
North India ◽  
Care Hospital

ABSTRACT Background: Alarming rise of vancomycin-resistant enterococci (VRE) is a global cause of concern. Several factors have been held responsible for such rise, of which antibiotic usage is a prominent one. Objectives: This study was undertaken to determine the intestinal VRE colonization rate amongst hospitalized patients in relation to use of various antibiotics in the Intensive Care Unit (ICU) of a tertiary care university hospital, India. Materials and Methods: Stool samples were collected weekly from all the patients in the adult ICU for a period of 6 months and processed for isolation and phenotypic and genotypic characterization of VRE isolates. Patient and treatment details were noted and cases (those with VRE in stool) and controls (those without VRE in stool) were compared statistically. Further, a multivariate analysis was done to identify those antibiotics as independent risk factors for VRE colonization. Results: VRE colonization was found in 34.56% (28/81) of the patients studied, with the majority 75% (21/28) carrying the vanA gene. The cases had significantly more (P < 0.05) duration of hospital stay and antibiotic exposure. Intake of metronidazole, vancomycin, and piperacillin-tazobactam were identified as significant risk factors both in univariate and multivariate analysis. Conclusion: A potential reservoir of VRE was thus revealed even in low VRE prevalence setting. Based on this high colonization status, restriction of empirical antibiotic use, reviewing of the ongoing antibiotic policy, and active VRE surveillance as an integral part of infection control strategy were suggested.

scholarly journals MALNUTRITION, SEPSIS AND TUMOR LYSIS SYNDROME ARE ASSOCIATED WITH INCREASED RATE OF ACUTE MORTALITY IN MATURE B CELL NON-HODGKIN LYMPHOMA IN PEDIATRIC POPULATION- STUDY FROM TERTIARY CARE HOSPITAL IN PAKISTAN

2019 ◽  
Vol 11 (1) ◽  
pp. 02019043
Author(s):  
Raheela Mansoor
Keyword(s):  
Risk Factors ◽  
Fungal Infection ◽  
B Cell ◽  
Pediatric Population ◽  
Tertiary Care ◽  
Tumor Lysis Syndrome ◽  
Significant Risk ◽  
Early Death ◽  
Care Hospital ◽  
Tumor Lysis

Background:            Outcomes of pediatric mature B cell NHL in resource challenged countries are negatively affected by increased rate of early and toxic deaths. Aim of this study is to assess rate of acute mortality and define significant risk factors present in children with mature B Cell NHL. Methods: A retrospective analysis was done of patients with B cell NHL from January 2012 till December 2016. Risk factors studied for acute mortality were malnutrition, stage, prior surgery with open laparotomy, LDH levels, tumor lysis syndrome, sepsis and fungal infection Results: Total 233 patients were enrolled in the study. Eighty five (36.4%) were below 15th percentile.  Treatment was started in 226 patients. Eighty eight percent children showed 20% response after COP pre-phase. Tumor lysis syndrome was developed in 20.6 % (n = 48) children and 42.9% (n = 100) patients had sepsis, 71/100 patients had culture proven sepsis. 19.7% (n = 46) patients developed fungal infection. There was 19.7% (n = 46) acute mortality.  Most common cause of death was sepsis (n = 22, 47.8%) followed by acute renal failure secondary to tumor lysis syndrome. On multivariate analysis, three independent variables found significant for early death are malnutrition, sepsis and tumor lysis syndrome. Conclusion: Rate of acute mortality in B cell NHL is high in our set up and significant risk factors are tumor lysis syndrome, sepsis and malnourishment at time of presentation.

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