scholarly journals Adherence to SATS antibiotic recommendations in patients with community acquired pneumonia in Johannesburg, South Africa

2016 ◽  
Vol 10 (04) ◽  
pp. 347-353 ◽  
Author(s):  
Murimisi Mukansi ◽  
Anastacia Chetty ◽  
Charles Feldman
Keyword(s):  
South Africa ◽  
Antibiotic Treatment ◽  
Patient Outcomes ◽  
Guideline Adherence ◽  
Length Of Hospital Stay ◽  
Community Acquired Pneumonia ◽  
Significant Difference ◽  
Empiric Antibiotic ◽  
High Level ◽  
The Impact

Introduction: Antibiotic guidelines have been published by various societies indicating the optimal empiric antibiotic treatment of patients with community acquired pneumonia (CAP); however, no studies have been undertaken in South Africa investigating whether the most recent South African Thoracic Society (SATS) antibiotic CAP guideline, published in 2007, is being adhered to, or whether adherence is associated with improved patient outcomes. Methodology: This was a retrospective record review over a one-year period undertaken to document levels of adherence to the 2007 SATS guideline for CAP management in adults at an academic teaching hospital. Results: A total of 181 patients with CAP were included in the study, of whom 101 were female, and 109 were known to be HIV-seropositive. The majority (66%) of the patients received antibiotic treatment that was guideline-adherent. In those patients who received treatment that was non-adherent to the guideline recommendations, rather than receiving inadequate cover, they actually had received treatment that was in excess of what was recommended.  There was no significant difference in the length of hospital stay among the two patient groups; however, a significantly longer time to clinical stability was found in patients who had received guideline-adherent treatment.  Only one CAP patient died and therefore it was not possible to determine the impact of guideline adherence on patient mortality. Conclusion: Results of this study indicated a relatively high level of SATS guideline adherence. Guideline adherence was not associated with improved patient outcomes.

scholarly journals 288. Follow-Up Blood Cultures in Gram-Negative Bacteremia: How Do They Impact Outcomes

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S144-S144
Author(s):  
Azza Elamin ◽  
Faisal Khan ◽  
Ali Abunayla ◽  
Rajasekhar Jagarlamudi ◽  
aditee Dash
Keyword(s):  
Clinical Outcomes ◽  
Antibiotic Treatment ◽  
Readmission Rate ◽  
Blood Cultures ◽  
Categorical Variables ◽  
Gram Negative ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Impact

Abstract Background As opposed to Staphylococcus. aureus bacteremia, there are no guidelines to recommend repeating blood cultures in Gram-negative bacilli bacteremia (GNB). Several studies have questioned the utility of follow-up blood cultures (FUBCs) in GNB, but the impact of this practice on clinical outcomes is not fully understood. Our aim was to study the practice of obtaining FUBCs in GNB at our institution and to assess it’s impact on clinical outcomes. Methods We conducted a retrospective, single-center study of adult patients, ≥ 18 years of age admitted with GNB between January 2017 and December 2018. We aimed to compare clinical outcomes in those with and without FUBCs. Data collected included demographics, comorbidities, presumed source of bacteremia and need for intensive care unit (ICU) admission. Presence of fever, hypotension /shock and white blood cell (WBC) count on the day of FUBC was recorded. The primary objective was to compare 30-day mortality between the two groups. Secondary objectives were to compare differences in 30-day readmission rate, hospital length of stay (LOS) and duration of antibiotic treatment. Mean and standard deviation were used for continuous variables, frequency and proportion were used for categorical variables. P-value < 0.05 was defined as statistically significant. Results 482 patients were included, and of these, 321 (67%) had FUBCs. 96% of FUBCs were negative and 2.8% had persistent bacteremia. There was no significant difference in 30-day mortality between those with and without FUBCs (2.9% and 2.7% respectively), or in 30-day readmission rate (21.4% and 23.4% respectively). In patients with FUBCs compared to those without FUBCs, hospital LOS was longer (7 days vs 5 days, P < 0.001), and mean duration of antibiotic treatment was longer (14 days vs 11 days, P < 0.001). A higher number of patients with FUBCs needed ICU care compared to those without FUBCs (41.4% and 25.5% respectively, P < 0.001) Microbiology of index blood culture in those with and without FUBCs Outcomes in those with and without FUBCs FUBCs characteristics Conclusion Obtaining FUBCs in GNB had no impact on 30-day mortality or 30-day readmission rate. It was associated with longer LOS and antibiotic duration. Our findings suggest that FUBCs in GNB are low yield and may not be recommended in all patients. Prospective studies are needed to further examine the utility of this practice in GNB. Disclosures All Authors: No reported disclosures

scholarly journals Influenza With an Infiltrate: Investigating the New Community-Acquired Pneumonia Guidelines

2020 ◽  
Vol 41 (S1) ◽  
pp. s302-s302
Author(s):  
Amanda Barner ◽  
Lou Ann Bruno-Murtha
Keyword(s):  
Demographic Data ◽  
Retrospective Chart Review ◽  
Vaccination Rate ◽  
Community Acquired Pneumonia ◽  
Teaching Hospitals ◽  
Antibiotic Prescribing ◽  
Supporting Evidence ◽  
Radiographic Findings ◽  
Significant Difference ◽  
The Impact

Background: The Infectious Diseases Society of America released updated community-acquired pneumonia (CAP) guidelines in October 2019. One of the recommendations, with a low quality of supporting evidence, is the standard administration of antibiotics in adult patients with influenza and radiographic evidence of pneumonia. Procalcitonin (PCT) is not endorsed as a strategy to withhold antibiotic therapy, but it could be used to de-escalate appropriate patients after 48–72 hours. Radiographic findings are not indicative of the etiology of pneumonia. Prescribing antibiotics for all influenza-positive patients with an infiltrate has significant implications for stewardship. Therefore, we reviewed hospitalized, influenza-positive patients at our institution during the 2018–2019 season, and we sought to assess the impact of an abnormal chest x-ray (CXR) and PCT on antibiotic prescribing and outcomes. Methods: We conducted a retrospective chart review of all influenza-positive admissions at 2 urban, community-based, teaching hospitals. Demographic data, vaccination status, PCT levels, CXR findings, and treatment regimens were reviewed. The primary outcome was the difference in receipt of antibiotics between patients with a negative (<0.25 ng/mL) and positive PCT. Secondary outcomes included the impact of CXR result on antibiotic prescribing, duration, 30-day readmission, and 90-day mortality. Results: We reviewed the medical records of 117 patients; 43 (36.7%) received antibiotics. The vaccination rate was 36.7%. Also, 11% of patients required intensive care unit (ICU) admission and 84% received antibiotics. Moreover, 109 patients had a CXR: 61 (55.9%) were negative, 29 (26.6%) indeterminate, and 19 (17.4%) positive per radiologist interpretation. Patients with a positive PCT (OR, 12.7; 95% CI, 3.43–60.98; P < .0007) and an abnormal CXR (OR, 7.4; 95% CI, 2.9–20.1; P = .000003) were more likely to receive antibiotics. There was no significant difference in 30-day readmission (11.6% vs 13.5%; OR, 0.89; 95% CI, 0.21–3.08; P = 1) and 90-day mortality (11.6% vs 5.4%; OR, 2.37; 95% CI, 0.48–12.75; P = .28) between those that received antibiotics and those that did not, respectively. Furthermore, 30 patients (62.5%) with an abnormal CXR received antibiotics and 21 (43.7%) had negative PCT. There was no difference in 30-day readmission or 90-day mortality between those that did and did not receive antibiotics. Conclusions: Utilization of PCT allowed selective prescribing of antibiotics without impacting readmission or mortality. Antibiotics should be initiated for critically ill patients and based on clinical judgement, rather than for all influenza-positive patients with CXR abnormalities.Funding: NoneDisclosures: None

scholarly journals Implementation of a specialist pneumonia intervention nurse service significantly lowers mortality for community acquired pneumonia

2019 ◽  
Author(s):  
Robert C. Free ◽  
Matthew Richardson ◽  
Camilla Pillay ◽  
Julie Skeemer ◽  
Kayleigh Hawkes ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Hospital Mortality ◽  
Antibiotic Treatment ◽  
Clinical Education ◽  
Guideline Adherence ◽  
Low Cost ◽  
Community Acquired Pneumonia ◽  
Bottom Line ◽  
Specialist Nurse ◽  
Guidelines Adherence

AbstractObjectivesEvaluate clinical outcomes associated with implementing a specialist pneumonia intervention nursing (SPIN) service, to improve adherence with BTS guidelines for hospitalised community acquired pneumonia (CAP).DesignRetrospective cohort study, comparing periods before (2011-13) and after (2014-16) SPIN service implementation.SettingSingle NHS trust across two hospital sites in Leicester City, EnglandParticipants13,496 adult (aged ≥16) admissions to hospital with a primary diagnosis of CAPInterventionsThe SPIN service was set up in 2013/2014 to provide clinical review of new CAP admissions; assurance of guidelines adherence; delivery of CAP clinical education and clinical follow up after discharge.Main outcome measuresThe primary outcomes were proportions of CAP cases receiving antibiotic treatment within 4 hours of admission and change in crude in-hospital mortality rate. Secondary outcomes were adjusted mortality rate and length of stay (LOS).ResultsThe SPIN service reviewed 38% of CAP admissions in 2014-16. 82% of these admissions received antibiotic treatment in <4 hours (68.5% in the national audit). Compared with the pre-SPIN period, there was a significant reduction in both 30-day (OR=0.77 [0.70-0.85], p<0.0001) and in-hospital mortality (OR=0.66 [0.60-0.73], p<0.0001) after service implementation, with a review by the service having the largest independent 30-day mortality benefit (HR=0.60 [0.53-0.67], p<0.0001). There was no change in LOS (median 6 days).ConclusionsImplementation of a SPIN service improves adherence with BTS guidelines and achieves significant reductions in CAP associated mortality. This enhanced model of care is low cost, highly effective and readily adoptable in secondary care.Key MessagesWhat is the key question?Does a specialist nurse-led intervention affect BTS guideline adherence and mortality for patients admitted to hospital with community acquired pneumonia (CAP)?What is the bottom line?Implementing specialist nurse teams for CAP delivers improved guideline adherence and survival for patients admitted with the condition.Why read on?This study shows a low-cost specialist nursing service focussed on CAP is associated with a significant improvement in BTS guidelines adherence and patient survival.

scholarly journals Alcohol withdrawal-related outcomes associated with gabapentin use in an inpatient psychiatric facility

2019 ◽  
Vol 9 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Taylor A. Nichols ◽  
Sophie Robert ◽  
David J. Taber ◽  
Jeffrey Cluver
Keyword(s):  
Alcohol Withdrawal ◽  
Length Of Hospital Stay ◽  
Control Cohort ◽  
Psychiatric Facility ◽  
Therapeutic Uses ◽  
Significant Difference ◽  
Benzodiazepine Use ◽  
The Impact ◽  
Hospital Stay Duration ◽  
Inpatient Psychiatric Facility

Abstract Introduction Limited evidence exists evaluating the impact of gabapentin in conjunction with benzodiazepines for the management of alcohol withdrawal. A review of outcomes associated with combination gabapentin and benzodiazepine therapy may illuminate new therapeutic uses in clinical practice. Methods This retrospective study evaluated the impact of gabapentin on as-needed use of benzodiazepines in inpatients being treated for acute alcohol withdrawal. The treatment cohort consisted of patients prescribed gabapentin while on a symptom-triggered alcohol withdrawal protocol. The control cohort consisted of patients on symptom-triggered alcohol withdrawal protocol without concurrent gabapentin use. Secondary objectives included length of hospital stay, duration on alcohol withdrawal protocol, frequency of complicated withdrawal, and use of additionally prescribed as-needed or scheduled benzodiazepines. Results The gabapentin cohort was on the alcohol withdrawal protocol for a similar duration, compared with the control cohort (median of 4 [interquartile range: 2,6] days vs 3 [2,4] days, P = .09, respectively). Similarly, the gabapentin cohort required a median of 1 [1,2] benzodiazepine dose for alcohol withdrawal symptoms compared with a median of 1 [1,2] dose in the control cohort, P = .89. No significant difference was found between cohorts for as-needed and scheduled benzodiazepine use. Length of stay in hospital was similar between groups. Discussion These results suggest that gabapentin use, in conjunction with benzodiazepines, impacts neither the time on alcohol withdrawal protocol or the number of benzodiazepine doses required for withdrawal. Larger, prospective studies are needed to detect if gabapentin alters benzodiazepine usage and to better elucidate gabapentin's role in acute alcohol withdrawal.

scholarly journals Markers of neutrophil extracellular traps predict adverse outcome in community-acquired pneumonia: secondary analysis of a randomised controlled trial

2018 ◽  
Vol 51 (4) ◽  
pp. 1701389 ◽  
Author(s):  
Fahim Ebrahimi ◽  
Stavros Giaglis ◽  
Sinuhe Hahn ◽  
Claudine A. Blum ◽  
Christine Baumgartner ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Secondary Analysis ◽  
Length Of Hospital Stay ◽  
Neutrophil Extracellular Traps ◽  
Community Acquired Pneumonia ◽  
Extracellular Traps ◽  
Clinical Instability ◽  
Randomised Controlled ◽  
The Impact ◽  
Clinical Stability

Neutrophil extracellular traps (NETs) are a hallmark of the immune response in inflammatory diseases. However, the role of NETs in community-acquired pneumonia (CAP) is unknown. This study aims to characterise the impact of NETs on clinical outcomes in pneumonia.This is a secondary analysis of a randomised controlled, multicentre trial. Patients with CAP were randomly assigned to either 50 mg prednisone or placebo for 7 days. The primary end-point was time to clinical stability; main secondary end-points were length of hospital stay and mortality.In total, 310 patients were included in the analysis. Levels of cell-free nucleosomes as surrogate markers of NETosis were significantly increased at admission and declined over 7 days. NETs were significantly associated with reduced hazards of clinical stability and hospital discharge in multivariate adjusted analyses. Moreover, NETs were associated with a 3.8-fold increased adjusted odds ratio of 30-day mortality. Prednisone treatment modified circulatory NET levels and was associated with beneficial outcome.CAP is accompanied by pronounced NET formation. Patients with elevated serum NET markers were at higher risk for clinical instability, prolonged length of hospital stay and 30-day all-cause mortality. NETs represent a novel marker for outcome and a possible target for adjunct treatments of pneumonia.

Blood enterovirus polymerase chain reaction testing in young febrile infants

2021 ◽  
pp. archdischild-2020-321077
Author(s):  
Carla Pintos ◽  
Santiago Mintegi ◽  
Javier Benito ◽  
Maitane Aranzamendi ◽  
Leire Bonilla ◽  
...  
Keyword(s):  
Antibiotic Treatment ◽  
Clinical Decision Making ◽  
Bacterial Pathogen ◽  
Length Of Hospital Stay ◽  
Clinical Decision ◽  
Dipstick Test ◽  
Urine Dipstick ◽  
Young Infants ◽  
Urine Dipstick Test ◽  
The Impact

ObjectiveTo analyse the impact of blood enterovirus and human parechovirus PCR (ev-PCR) testing in young infants with fever without a source (FWS).DesignObservational study, subanalysis of a prospective registry.SettingPaediatric emergency department.PatientsInfants ≤90 days of age with FWS seen between September 2015 and August 2019 with blood ev-PCR, blood and urine cultures and urine dipstick test performed.Main outcome measuresPrevalence of invasive bacterial infection (IBI: bacterial pathogen in blood or cerebrospinal fluid) in infants with positive or negative ev-PCR test results. Secondarily, we also compared length of stay and antibiotic treatment in hospitalised infants.ResultsOf 703 infants, 174 (24.7%) had a positive blood ev-PCR and none of them were diagnosed with an IBI (vs 2.6% (95% CI 1.3% to 4.0%) of those with a negative result, p=0.02). Prevalence of non-IBI (mainly urinary tract infection) was also lower among infants with a positive blood ev-PCR (2.3% (95% CI 0.1% to 4.5%) vs 17.6% (95% CI 14.3% to 20.8%), p<0.01).Overall, 258 infants were hospitalised (36.6%) and 193 (74.8%) of them received antibiotics. Length of hospital stay and antibiotic treatment were shorter in those with a positive blood ev-PCR (median: 3 days vs 5 days and 1 day vs 5 days, respectively; p<0.01). Differences remained statistically significant among well-appearing infants >21 days old with normal urine dipstick.ConclusionBlood ev-PCR identifies a group of infants under 90 days of age with FWS at very low risk of IBI. This test may help to guide clinical decision making in young febrile infants.

scholarly journals The Impact of COVID-19 on Hospitalised COPD Exacerbations in Malta

2021 ◽  
Vol 2021 ◽  
pp. 1-7
Author(s):  
Yvette Farrugia ◽  
Bernard Paul Spiteri Meilak ◽  
Neil Grech ◽  
Rachelle Asciak ◽  
Liberato Camilleri ◽  
...  
Keyword(s):  
Length Of Hospital Stay ◽  
Chronic Obstructive ◽  
Inpatient Mortality ◽  
Obstructive Pulmonary Disease ◽  
Predictors Of Mortality ◽  
Copd Exacerbations ◽  
Number Of Patients ◽  
Significant Difference ◽  
The Difference ◽  
The Impact

Introduction and Aims. The first COVID-19 case in Malta was confirmed on the 7th of March 2020. This study is aimed at investigating a significant difference between the number of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) admissions and their inpatient outcome at Mater Dei Hospital during the COVID-19 pandemic when compared to the same period in 2019. Furthermore, we aim to determine predictors of mortality in AECOPD inpatients. Method. Data was collected retrospectively from electronic hospital records during the periods 1st March until 10th May in 2019 and 2020. Results. There was a marked decrease in AECOPD admissions in 2020, with a 54.2% drop in admissions ( n = 119 in 2020 vs. n = 259 in 2019). There was no significant difference in patient demographics or medical comorbidities. In 2020, there was a significantly lower number of patients with AECOPD who received nebulised medications during admission (60.4% in 2020 vs. 84.9% in 2019; p ≤ 0.001 ). There were also significantly lower numbers of AECOPD patients admitted in 2020 who received controlled oxygen via venturi masks (69.0% in 2020 vs. 84.5% in 2019; p = 0.006 ). There was a significant increase in inpatient mortality in 2020 (19.3% [ n = 23 ] and 8.4% [ n = 22 ] for 2020 and 2019, respectively, p = 0.003 ). Year was found to be the best predictor of mortality outcome ( p = 0.001 ). The lack of use of SABA pre-admission treatment ( p = 0.002 ), active malignancy ( p = 0.003 ), and increased length of hospital stay ( p = 0.046 ) were also found to be predictors of mortality for AECOPD patients; however, these parameters were unchanged between 2019 and 2020 and therefore could not account for the increase in mortality. Conclusions. There was a decrease in the number of admissions with AECOPD in 2020 during the COVID-19 pandemic, when compared to 2019. The year 2020 proved to be a significant predictor for inpatient mortality, with a significant increase in mortality in 2020. The decrease in nebuliser and controlled oxygen treatment noted in the study period did not prove to be a significant predictor of mortality when corrected for other variables. Therefore, the difference in mortality cannot be explained with certainty in this retrospective cohort study.

scholarly journals Geographical and industry differences on remuneration gap-enhanced labour productivity levels in a developing economy: South Africa as a case study

2012 ◽  
Vol 5 (2) ◽  
pp. 499-514 ◽  
Author(s):  
Gerhardus Van Zyl
Keyword(s):  
South Africa ◽  
Labour Productivity ◽  
Negative Sign ◽  
Developing Economy ◽  
Significant Difference ◽  
The Impact

The aim of the article was to determine the geographic and industry differences for employee-remuneration gap-enhanced labour productivity levels in a developing economy. The Winter-Ebmer and Zweimuller model was used to estimate the signs and magnitudes of the employee-remuneration gap-enhanced labour productivity levels for the different industries in the different geographical areas. The estimation results for all three industries indicated a significant difference between the higher gross geographical product (GGP) provinces and the lower GGP provinces in terms of the employee-remuneration gap-enhanced labour productivity indicator coefficients (ERGLP indicator coefficients). The negative sign of the ERGLP indicator coefficients for the industries of some of the lower GGP provinces relates to the non-existence of any possible positive labour productivity effects that might stem from employee-remuneration gaps. The introduction of business uncertainty resulted in smaller ERGLP indicator coefficients across all industries and geographical areas. The impact was much more severe in the case of the lower GGP provinces

scholarly journals COMPARISON OF ANTIBIOTICS;

2018 ◽  
Vol 21 (04) ◽  
pp. 667-671
Author(s):  
Shahid Mahmood ◽  
Asma Tariq
Keyword(s):  
Febrile Neutropenia ◽  
Antibiotic Treatment ◽  
Oral Antibiotic ◽  
Granulocyte Colony Stimulating Factor ◽  
Colony Stimulating Factor ◽  
Significant Difference ◽  
Empiric Antibiotic ◽  
Group A ◽  
Group B ◽  
Stimulating Factor

Objective: To determine if granulocyte colony-stimulating factor (G-CSF) withempirical antibiotics therapy accelerates febrile neutropenia resolution compared with antibioticswithout it. Study design: Experimental study. Place and Duration of Study: Study wasconducted for a period of one year from march 2012 to february 2013 in oncology/haematologydepartment Children Hospital Lahore (PAKISTAN). Subject and Methods: A total of 56 childrenwith febrile neutropenia due to chemotherapy were included in the study. Two groups were madeA and B. Twenty eight patients were included in each group. Patients included in the group Awere given granulocyte colony stimulating factor with the dose of 5 microg/kg/day for five daysand the patients included in group B were not given granulocyte colony stimulating factor.Subcutaneous administration was recommended. Patients remained on study until absoluteneutrophil count (ANC) >500/microl and > or =48 hr without fever. Every child in both groupswas given antibiotic treatment in the hospital whenever there is need, antibiotics changedaccording to the blood culture sensitivity. Admitted patients were followed daily for fever andsigns of sepsis. Number of days of admission in hospital and number of days of treatment wascalculated in both groups and compared with each other. Duration of febrile neutropenia andmortality was also analysed for both groups. Results: Out of 56 patients 46 had acutelymphoblastic leukemia (ALL), 06 patients were of wilm tumour and 04 patient were havingrhabdomyosarcoma. Twenty eight patients were given only antibiotics(GROUP B) and 28patients were given G-CSF plus antibiotics(GROUP A). Addition of G-CSF significantly reducedneutropenia and febrile neutropenia recovery times. Median days to febrile neutropeniaresolution was 4.3 days earlier with G-CSF (5.3 vs. 9.6 days) (P < 0.0001). Resolution of fever wasone day earlier in patients who were given G-CSF (GROUP A). Hospitalization was 2.1 daysshorter with G-CSF (6.1 vs. 8.2 days) (P = 0.02). (Table II). There was difference of 2.2 days in theduration of IV and oral antibiotic treatment. Addition of antifungal therapy was done in 4 patientsin group B and only in one patient in group A. All the patients recovered and no death occurred inthe study. Conclusions: It is concluded that addition of G-CSF to empiric antibiotic therapyaccelerates chemothserapy-induced febrile neutropenia resolution by 4.3 days in pediatricpatients with malignancy. It is a significant difference in duration of hospitalization. By bearingexpenses of G-CSF we can decrease the expenses of hospitalization and antibiotics

Sign in / Sign up

Export Citation Format

Share Document