scholarly journals Controlling for Severity of Illness in Outcome Studies Involving Infectious Diseases: Impact of Measurement at Different Time Points

2008 ◽  
Vol 29 (11) ◽  
pp. 1048-1053 ◽  
Author(s):  
Kerri A. Thom ◽  
Michelle D. Shardell ◽  
Regina B. Osih ◽  
Marin L. Schweizer ◽  
Jon P. Furuno ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Hospital Mortality ◽  
Antimicrobial Therapy ◽  
Severity Of Illness ◽  
Multivariate Logistic Regression ◽  
Gram Negative ◽  
Time Points ◽  
Gram Negative Bacteremia ◽  
Appropriate Therapy ◽  
The Impact

Background.Severity of illness is an important confounder in outcome studies involving infectious diseases. However, it is unclear whether the time at which severity of illness is measured is important.Methods.We performed a retrospective study of 328 episodes of gram-negative bacteremia in adult patients to assess the impact of the time of measurement of severity of illness on the association between empirical antimicrobial therapy received and in-hospital mortality. Using a modified Acute Physiology Score (APS), severity of illness was measured at 2 time points: (1) hospital admission and (2) 24 hours before the first culture-positive blood sample was collected. Multivariate logistic regression was used to estimate the impact of adjusting for the APS on the relationship between empirical therapy received (ie, the exposure) and in-hospital mortality (ie, the outcome).Results.The mean APS ( ± standard deviation) of patients with bacteremia increased during their hospital stay (from 19.2 ± 11.6 at admission to 24.2 ± 13.6 at the second time point; P < .01). When examining the association between empirical antimicrobial therapy received and in-hospital mortality, and controlling for the APS, there was a trend toward a decreased impact of appropriate therapy received on in-hospital mortality. The unadjusted odds ratio (OR) for the association between appropriate therapy received and in-hospital mortality was 0.83 (95% confidence interval [CI], 0.51-1.34). After controlling for the APS at admission, this association was attenuated (OR, 0.94 [95% CI, 0.57-1.55]), and when a change in the APS was also included in the multivariate logistic regression model, the association was further attenuated (OR, 0.99 [95% CI, 0.58-1.69]).Conclusions.The magnitude of the association between appropriate antimicrobial therapy received and in-hospital mortality among patients with gram-negative bacteremia was sensitive to the timing of adjustment for severity of illness.

Automated Alerts Coupled with Antimicrobial Stewardship Intervention Lead to Decreases in Length of Stay in Patients with Gram-Negative Bacteremia

2014 ◽  
Vol 35 (2) ◽  
pp. 132-138 ◽  
Author(s):  
Jason M. Pogue ◽  
Ryan P. Mynatt ◽  
Dror Marchaim ◽  
Jing J. Zhao ◽  
Viktorija O. Barr ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Blood Culture ◽  
Antimicrobial Stewardship ◽  
Positive Blood Culture ◽  
Medical Center ◽  
Intervention Group ◽  
Gram Negative ◽  
Gram Negative Bacteremia ◽  
Appropriate Therapy ◽  
The Impact

Objective.To assess the impact of active alerting of positive blood culture data coupled with stewardship intervention on time to appropriate therapy, length of stay, and mortality in patients with gram-negative bacteremia.Design.Quasi-experimental retrospective cohort study in patients with gram-negative bacteremia at the Detroit Medical Center from 2009 to 2011.Setting.Three hospitals (1 community, 2 academic) with active antimicrobial stewardship programs within the Detroit Medical Center.Patients.All patients with monomicrobial gram-negative bacteremia during the study period.Intervention.Active alerting of positive blood culture data coupled with stewardship intervention (2010-2011) compared with patients who received no formalized stewardship intervention (2009).Results.Active alerting and intervention led to a decreased time to appropriate therapy (8 [interquartile range (IQR), 2-24] vs 14 [IQR, 2-35] hours; P = .014) in patients with gram-negative bacteremia. After controlling for differences between groups, being in the intervention arm was associated with an independent reduction in length of stay (odds ratio [OR], 0.73 [95% confidence interval (CI), 0.62-0.86]), correlating to a median attributable decrease in length of stay of 2.2 days. Additionally, multivariate modeling of patients who were not on appropriate antimicrobial therapy at the time of initial culture positivity showed that patients in the intervention group had a significant reduction in both length of stay (OR, 0.76 [95% CI, 0.66-0.86]) and infection-related mortality (OR, 0.24 [95% CI, 0.08-0.76]).Conclusions.Active alerting coupled with stewardship intervention in patients with gram-negative bacteremia positively impacted time to appropriate therapy, length of stay, and mortality and should be a target of antimicrobial stewardship programs.

scholarly journals The second pregnancy has no effect in the incidence of macrosomia: a cross-sectional survey in two western Chinese regions

2021 ◽  
Vol 40 (1) ◽  
Author(s):  
Li Luo ◽  
Huan Zeng ◽  
Mao Zeng ◽  
Xueqing Liu ◽  
Xianglong Xu ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Western China ◽  
Fetal Macrosomia ◽  
Multivariate Logistic Regression Model ◽  
Multivariate Logistic Regression ◽  
Cross Sectional ◽  
Second Child ◽  
Child Policy ◽  
Significant Difference ◽  
The Impact

Abstract Background After the implementation of the universal two-child policy in China, the increase in parity has led to an increase in adverse pregnancy outcomes. The impact of one and two fetuses on the incidence of fetal macrosomia has not been fully confirmed in China. This study aimed to explore the differences in the incidence of fetal macrosomia in first and second pregnancies in Western China after the implementation of the universal two-child policy. Methods A total of 1598 pregnant women from three hospitals were investigated by means of a cross-sectional study from August 2017 to January 2018. Participants were recruited by convenience and divided into first and second pregnancy groups. These groups included 1094 primiparas and 504 women giving birth to their second child. Univariate and multivariate logistic regression analyses were performed to discuss the differences in the incidence of fetal macrosomia in first and second pregnancies. Results No significant difference was found in the incidence of macrosomia in the first pregnancy group (7.2%) and the second pregnancy group (7.1%). In the second-time pregnant mothers, no significant association was found between the macrosomia of the second child (5.5%) and that of the first child (4.7%). The multivariate logistic regression model showed that mothers older than 30 years are not likely to give birth to children with macrosomia (odds ratio (OR) 0.6, 95% confidence interval (CI) 0.4,0.9). Conclusions The incidence of macrosomia in Western China is might not be affected by the birth of the second child and is not increased by low parity.

Reply to comments: duration of antimicrobial therapy for Gram-negative bacteremia secondary to urinary source of infection

Infection ◽  
2018 ◽  
Vol 46 (2) ◽  
pp. 283-284 ◽  
Author(s):  
Majdi N. Al-Hasan ◽  
Avery N. Nelson ◽  
Julie Ann Justo ◽  
Helmut Albrecht ◽  
Joseph Kohn ◽  
...  
Keyword(s):  
Antimicrobial Therapy ◽  
Gram Negative ◽  
Source Of Infection ◽  
Gram Negative Bacteremia

scholarly journals Evaluation of the impact of the Accelerate Pheno™ system on time to result for differing antimicrobial stewardship intervention models in patients with gram-negative bloodstream infections

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Gerald Elliott ◽  
Michael Malczynski ◽  
Viktorjia O. Barr ◽  
Doaa Aljefri ◽  
David Martin ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Bloodstream Infections ◽  
Standard Of Care ◽  
Resistance Mechanisms ◽  
Gram Negative ◽  
Intervention Models ◽  
Gram Negative Bacteremia ◽  
Potential Impact ◽  
Potential Clinical Impact ◽  
The Impact

Abstract Background Initiating early effective antimicrobial therapy is the most important intervention demonstrated to decrease mortality in patients with gram-negative bacteremia with sepsis. Rapid MIC-based susceptibility results make it possible to optimize antimicrobial use through both escalation and de-escalation. Method We prospectively evaluated the performance of the Accelerate Pheno™ system (AXDX) for identification and susceptibility testing of gram-negative species and compared the time to result between AXDX and routine standard of care (SOC) using 82 patient samples and 18 challenge organisms with various confirmed resistance mechanisms. The potential impact of AXDX on time to antimicrobial optimization was investigated with various simulated antimicrobial stewardship (ASTEW) intervention models. Results The overall positive and negative percent agreement of AXDX for identification were 100 and 99.9%, respectively. Compared to VITEK® 2, the overall essential agreement was 96.1% and categorical agreement was 95.4%. No very major or major errors were detected. AXDX reduced the time to identification by an average of 11.8 h and time to susceptibility by an average of 36.7 h. In 27 patients evaluated for potential clinical impact of AXDX on antimicrobial optimization, 18 (67%) patients could potentially have had therapy optimized sooner with an average of 18.1 h reduction in time to optimal therapy. Conclusion Utilization of AXDX coupled with simulated ASTEW intervention notification substantially shortened the time to potential antimicrobial optimization in this cohort of patients with gram-negative bacteremia. This improvement in time occurred when ASTEW support was limited to an 8-h coverage model.

P2744Age distribution of valvular heart disease in China: from a national multicenter prospective cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
B Zhang ◽  
H T Zhang ◽  
H Y Xu ◽  
Y J Wu
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Heart Disease ◽  
Mitral Valve ◽  
Valvular Heart Disease ◽  
Mitral Valve Disease ◽  
Multimodality Imaging ◽  
Valve Disease ◽  
Multivariate Logistic Regression ◽  
The Impact

Abstract Background Valvular heart disease (VHD) has been caught in two important cross-currents in recent decades: aging demography and the rise of multimodality imaging and transcatheter valve therapy. In this setting, we aim to identify the distribution, characteristics, and management of Chinese VHD patients according to age. Methods China Valvular Heart Disease Cohort Study (China-VHD) was conducted from March to September 2019 in 46 centers over China. It included prospectively 12331 adults with native moderate or severe VHD, of which we described the distribution, management, and in-hospital events according to age (18–44, 45–54, 55–64, 65–74, ≥75). Multivariate Logistic regression was employed to investigate the impact of age on in-hospital events composed of in-hospital mortality, acute heart failure, and stoke. Results In Chinese VHD population, overall percentage peaked in 55–64 year olds. The frequency of multivalvular heart disease (MVHD) saw an increasing trend with age (p for trend <0.001). Of single valvular heart disease, mitral regurgitation (MR) was the most frequent left-sided VHD followed by aortic regurgitation (AR), aortic stenosis (AS), and mitral stenosis (MS). AS frequency significantly grew with age (p for trend = 0.02) while AR peaked in 18–44 year olds and fluctuated at a lower level in the older population. In contrast, mitral valve disease (MS, MR, and mixed mitral valve disease) was most frequent in 45–54 year olds and dropped with age (p for trend all <0.001). Noteworthily, all aortic valve disease was notably frequent in men whereas mitral valve disease and MVHD more common in women. Similar to developed countries, degenerative etiology rose steeply while rheumatic and congenital origin fell with age. Regarding management, surgical valve replacement rate was similar in age groups lower than 75 years old with increasing frequency of concomitant CABG. No matter aortic or mitral, the percentage of bio-prosthesis rocketed after 65 years (aortic: 74.7%, mitral: 70.6%). In multivariate logistic regression, covariables included age, sex, BMI, hypertension, diabetes, coronary heart disease, aortic disease, cardiomyopathy, COPD, NYHA class and valvular intervention. Compared to patients younger than 45, in-hospital events significantly higher in patients over 75 only (OR: 1.69 [95% CI: 1.07–2.66], p<0.02). Moreover, women showed a lower risk of in-hospital events (OR: 0.78 [95% CI: 0.63–0.96], p<0.01). Age distribution of VHD Conclusion Age plays a crucial role in valvular heart disease, best illustrated in AS. Unlike the western world, AR and MR are more frequent than AS but show a slightly decreasing trend with age. As expected, degenerative etiology is becoming more prevalent whereas rheumatism decreases. Age over 75 and male are associated with growing in-hospital events. Degenerative VHD thus present an important public-health burden. Acknowledgement/Funding Innovation project of Chinese academy of medical science

scholarly journals 1033. Effectiveness of a Physician-Driven Automated Antibiotic Time Out in the Setting of Gram-negative Bacteremia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S363-S364
Author(s):  
Sana Mohayya ◽  
Navaneeth Narayanan ◽  
Daniel Cimilluca ◽  
Parth Vaidya ◽  
Alexander Malanowski ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Primary Outcome ◽  
Secondary Outcome ◽  
Antibiotic Prescribing ◽  
Gram Negative ◽  
Time Out ◽  
Days Of Therapy ◽  
Gram Negative Bacteremia ◽  
Secondary Outcomes ◽  
The Impact

Abstract Background In an effort to minimize complications associated with over-utilization of antibiotics, many antimicrobial stewardship programs have incorporated an antibiotic time out (ATO). Despite the increasing adoption of the ATO, limited data are available to support its effectiveness. This study was designed to assess the impact of an automated ATO integrated into the electronic medical record (EMR) on the rate of antibiotic modification in patients receiving broad-spectrum antibiotic(s) for Gram-negative bacteremia (GNB). Methods This was a single-center retrospective cohort study of inpatients from January 2017 to June 2018 conducted at a large academic medical center. ATO was implemented on October 31, 2017. Adult patients with GNB who received at least 72 hours of a systemic antibiotic were included. Patients with neutropenia or polymicrobial infections were excluded. The primary outcome was the proportion of patients who received a modification of therapy within 24 hours of final culture results. Secondary outcomes included modification at any point in therapy, time to modification of therapy, time to de-escalation, and days of therapy of broad-spectrum antibiotics. Results There was a total of 88 patients who met inclusion criteria, 37 patients pre-ATO and 51 patients post-ATO. The primary outcome of modification of therapy within 24 hours of final culture results was not significantly different for patients in the pre-ATO and post-ATO groups (19% vs. 20%, P = 0.94, respectively). The secondary outcome of modification of therapy at any point in therapy was not significantly different between the two groups (62% vs. 66%, P = 0.67). Of the 47 patients who received a modification of therapy, the mean time to modification was significantly shorter in the post-ATO group (52.8 hours vs. 45.26 hours, P < 0.05,). All other secondary outcomes were not significantly different between study groups. Conclusion The ATO alert was not associated with a higher rate of antibiotic modification within 24 hours of culture results in patients with GNB, although there was a significant reduction in the time to antibiotic modification. Further efforts are needed to improve the time to modification and optimize antibiotic prescribing practices. Disclosures All authors: No reported disclosures.

scholarly journals Shorter-course Antimicrobial Therapy for Uncomplicated Gram-negative Bacteremia: Is It Generalizable?

2019 ◽  
Vol 69 (7) ◽  
pp. 1263-1263
Author(s):  
Scott J C Pallett ◽  
Stephen Hughes ◽  
Muhammed U Ebrahimsa ◽  
Nabeela Mughal ◽  
Luke S P Moore
Keyword(s):  
Antimicrobial Therapy ◽  
Gram Negative ◽  
Gram Negative Bacteremia

scholarly journals Association of body temperature with in-hospital mortality among paediatric trauma patients: an analysis of a nationwide observational trauma database in Japan

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e033822
Author(s):  
Asami Okada ◽  
Yohei Okada ◽  
Hiromichi Narumiya ◽  
Wataru Ishii ◽  
Tetsuhisa Kitamura ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Body Temperature ◽  
Hospital Mortality ◽  
Multivariate Logistic Regression Analysis ◽  
Data Bank ◽  
Trauma Patients ◽  
Multivariate Logistic Regression ◽  
Hospital Arrival ◽  
Paediatric Trauma ◽  
Japan Trauma Data Bank

ObjectivesTo examine the association between body temperature (BT) on hospital arrival and in-hospital mortality among paediatric trauma patients.DesignA retrospective cohort study.SettingJapan Trauma Data Bank (JTDB, which is a nationwide, prospective, observational trauma registry with data from 235 hospitals).ParticipantsPaediatric trauma patients <16 years old who were transferred directly from the scene of injury to the hospital and registered in the JTDB from January 2004 to December 2017 were included. We excluded patients >16 years old and those who developed cardiac arrest before or on hospital arrival.Primary outcomeThe association between BT on hospital arrival and in-hospital mortality. We conducted multivariate logistic regression analyses to calculate the adjusted ORs, with their 95% CIs, of the association between BT and in-hospital mortality.ResultsA total of 9012 patients were included (median age: 9 years (IQR, 6.0–13.0 years), mortality: 2.5% (mortality number was 226 in total 9012 patients)). In the multivariate logistic regression analysis, the corresponding adjusted ORs of BT <36.0°C and BT ≥37.0°C, relative to a BT of 36°C–36.9°C, for in-hospital mortality were 2.83 (95% CI: 1.85 to 4.33) and 0.93 (95% CI: 0.53 to 1.63), respectively.ConclusionsIn paediatric patients with hypothermia (BT <36.0°C) on hospital arrival, a clear association with in-hospital mortality was observed; no such association was observed between higher BT values (≥37.0°C) and outcomes.

scholarly journals Pharmacist-Driven Implementation of Fast Identification and Antimicrobial Susceptibility Testing Improves Outcomes for Patients with Gram-Negative Bacteremia and Candidemia

2020 ◽  
Vol 64 (9) ◽  
Author(s):  
Sahil Sheth ◽  
Michael Miller ◽  
Angela Beth Prouse ◽  
Scott Baker
Keyword(s):  
Targeted Therapy ◽  
Antibiotic Therapy ◽  
Antimicrobial Susceptibility ◽  
Susceptibility Testing ◽  
Antimicrobial Susceptibility Testing ◽  
Gram Negative ◽  
Fast Identification ◽  
Intensity Score ◽  
Gram Negative Bacteremia ◽  
The Impact

ABSTRACT Bloodstream infections (BSI) are associated with increased morbidity and mortality, especially when caused by Gram-negative or fungal pathogens. The objective of this study was to assess the impact of fast identification-antimicrobial susceptibility testing (ID/AST) with the Accelerate Pheno system (AXDX) from May 2018 to December 2018 on antibiotic therapy and patient outcomes. A pre-post quasiexperimental study of 200 patients (100 pre-AXDX implementation and 100 post-AXDX implementation) was conducted. The primary endpoints measured were time to first antibiotic intervention, time to most targeted antibiotic therapy, and 14-day hospital mortality. Secondary endpoints included hospital and intensive care unit (ICU) length of stay (LOS), antibiotic intensity score at 96 h, and 30-day readmission rates. Of 100 patients with Gram-negative bacteremia or candidemia in each cohort, 84 in the preimplementation group and 89 in the AXDX group met all inclusion criteria. The AXDX group had a decreased time to first antibiotic intervention (26.3 versus 8.0, P = 0.003), hours to most targeted therapy (14.4 versus 9, P = 0.03), hospital LOS (6 versus 8, P = 0.002), and average antibiotic intensity score at 96 h (16 versus 12, P = 0.002). Both groups had a comparable 14-day mortality (0% versus 3.6%, P = 0.11). In this analysis of patients with Gram-negative bacteremia or candidemia, fast ID/AST implementation was associated with decreased hospital LOS, decreased use of broad-spectrum antibiotics, shortened time to targeted therapy, and an improved utilization of antibiotics within the first 96 h of therapy.

Impact of the primary information source used for decision making and implications for treatment regret in prostate cancer.

2017 ◽  
Vol 35 (6_suppl) ◽  
pp. 17-17 ◽  
Author(s):  
Narek Shaverdian ◽  
Amar Upadhyaya Kishan ◽  
Darlene Veruttipong ◽  
D. Jeffrey Demanes ◽  
Patrick Kupelian ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Logistic Regression ◽  
Radiation Treatment ◽  
Information Source ◽  
The Internet ◽  
Radiation Oncologist ◽  
Multivariate Logistic Regression ◽  
Treatment Experience ◽  
The Impact

17 Background: Patients with localized prostate cancer (PCa) assimilate information from varying sources to inform their treatment decision. We assessed the impact of the primary information source used to select a modern radiation treatment on patient perceptions of their treatment experience and on treatment regret. Methods: Patients with favorable-risk PCa treated with SBRT, IMRT or HDR brachytherapy and at least one year of follow-up were surveyed. The questionnaire explored the decision-making experience, expected treatment experience vs. the reality, and treatment regret via a validated tool. Multivariate logistic regression adjusted for demographics, disease characteristics, treatment modality, time since treatment and current bowel, urinary and sexual function. Results: 322 consecutive patients were surveyed with an 86% (n = 276) response rate. 48% (n = 132) selected their radiation oncologist as the primary information source, 23% (n = 62) selected their urologist, 16% (n = 44) selected the internet, 6% (n = 17) selected other patients and 8% (n = 21) selected other. Overall, 13% (n = 36) endorsed treatment regret. 39% of patients who selected the internet as their primary information source reported their actual treatment experience to be worse than expected vs. 13% of respondents who selected their urologist, 12% who selected other patients, 2% who selected their radiation oncologist and 9% who selected other ( p< 0.01). Similarly, 43% who selected the internet as their primary information source endorsed treatment regret vs. 10% who selected their urologist, 7% who selected their radiation oncologist, 6% who selected other patients and 6% who selected other ( p< 0.01). On multivariate logistic regression, only patients who selected the internet as their primary information source were more likely to endorse treatment regret (OR = 46.5, p< 0.01) and were more likely to choose a treatment they thought ‘had the least side effects’ (OR = 2.1, p= 0.016). Conclusions: Patients who used the internet as their primary source of information had a worse perception of their treatment experience and had more treatment regret, highlighting the need for physicians to proactively counsel patients.

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