scholarly journals Long-Term Outcomes in Patients on Life-Long Antibiotics: A Five-Year Cohort Study

Antibiotics ◽  
2022 ◽  
Vol 11 (1) ◽  
pp. 62
Author(s):  
Christopher Kiss ◽  
Declan Connoley ◽  
Kathryn Connelly ◽  
Kylie Horne ◽  
Tony Korman ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Descriptive Analysis ◽  
Recurrent Infection ◽  
Antibiotic Consumption ◽  
Long Term Outcomes ◽  
Curative Therapy ◽  
Individual Level ◽  
Carbapenem Resistant ◽  
Level Hospital

Background: Little is known about the impacts at an individual level of long-term antibiotic consumption. We explored health outcomes of long-term antibiotic therapy prescribed to a cohort of patients to suppress infections deemed incurable. Methods: We conducted a 5-year longitudinal study of patients on long-term antibiotics at Monash Health, a metropolitan tertiary-level hospital network in Australia. Adults prescribed antibiotics for >12 months to suppress chronic infection or prevent recurrent infection were included. A retrospective review of medical records and a descriptive analysis was conducted. Results: Twenty-seven patients were followed up during the study period, from 29 patients originally identified in Monash Health in 2014. Seven of the 27 patients (26%) died from causes unrelated to the suppressed infection, six (22%) ceased long-term antibiotic therapy and two (7%) required treatment modification. Fifteen (56%) were colonised with multiresistant microorganisms, including vancomycin resistant Enterococci, methicillin resistant Staphylococcus aureus, and carbapenem resistant Enterobacteriaciae. Conclusions: This work highlights the potential pitfalls of long-term antibiotic therapy, and the frailty of this cohort, who are often ineligible for definitive curative therapy.

scholarly journals EVALUASI KUALITATIF PENGGUNAAN ANTIBIOTIK PADA PASIEN ANAK DENGAN METODE GYSSENS DI RSUD KARAWANG

2019 ◽  
Vol 4 (1) ◽  
pp. 297-302
Author(s):  
Diany Astuti ◽  
Yuli Nurhayati
Keyword(s):  
Antimicrobial Resistance ◽  
Antibiotic Therapy ◽  
Typhoid Fever ◽  
Pediatric Patients ◽  
Descriptive Analysis ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Antibiotics Resistance ◽  
Data Sampling ◽  
Inappropriate Use

ABSTRAK             Peresepan antibiotik untuk pasien anak-anak paling banyak digunakan dalam terapi. Penggunaan Antibiotik untuk anak-anak harus diawasi dan dikendalikan karena penggunaan antibiotik yang tidak terkontrol dan tidak tepat dapat berdampak pada kegagalan efek terapi yang diharapkan dan kemungkinan dapat meyebabkan resistensi antimikroba.  Pemakaian antibiotik harus dianalisis untuk mengendalikan resistensi antibiotik.  Tujuan penelitian ini untuk menilai rasionalitas terapi antibiotik pada pasien anak. Penelitian ini merupakan analisis deskriptif retrospektif dengan pengambilan data purposive sampling. Subjek dari penelitian adalah rekam medis dari bangsal anak RSUD Karawang. Rasionalitas penggunaan antibiotik adalah penilaian melalui metode gyssens. 147 data dianalisis untuk penelitian ini terdiri dari anak laki-laki (54,40%) dan perempuan (45,60%) dengan kasus demam tifoid (53,10), diare (24,5%) dan bronkopneumonia (22,4%). Antibiotik yang digunakan sefotaksim (71,43%), amoksisilin (5,44%) dan kloramfenikol (4,76%). Penilaian antibiotik melalui metode Gyssens adalah skala IVA (93,20%), skala IIB (6,12%) dan skala IIIA (0,68%). Kata Kunci: Antibiotik, Rasionalitas, Metode Gyssens.   ABSTRACT             Antibiotics prescription for pediatric patients is most widely used in therapy. Antibiotic use for pediatric must be watched and controlled because uncontrolled and inappropriate use of antibiotic can impact on failure of expected therapeutic effect and can also cause the possibility of antimicrobial resistance. Antibiotic consumption is must analyzed for controlling the antibiotics resistance. The aim of study The aim of this study was to assess the rationality of antibiotic therapy in pediatric patients. This research is a retrospective descriptive analysis with purposive data sampling. Subject of study are medical record from pediatric ward in RSUD Karawang. Rationality used of antibiotic is asses through Gyssens method. 147 data was analyzed for this study consist of boys (54,40%) and girls (45,60%) with case of typhoid  fever (53,10), diarrhea (24,5%) and bronchopneumonia (22,4%). Antibiotic was use Cefotaxime (71,43%), Amoxicillin (5,44%), Chloramphenicol (4,76%)etc.  Assessment  antibiotic through Gyssens method are IVA scale (93,20%), IIB scale ( 6,12%) and IIIA scale (0,68%). Keyword : Antibiotic, Rationality, Gyssens Method.

scholarly journals 2667. Does Ceftazidime–Avibactam (CAZ-AVI) Improve Short- and Long-Term Outcomes Among Solid-Organ Transplant (SOT) Recipients with Carbapenem-Resistant Enterobacteriaceae (CRE) Infections?

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S934-S935
Author(s):  
Jonathan Sun ◽  
Cornelius J Clancy ◽  
Ryan K Shields ◽  
Minh-Hong Nguyen
Keyword(s):  
Organ Transplant ◽  
Recurrent Infection ◽  
Solid Organ ◽  
Recurrent Infections ◽  
Long Term Outcomes ◽  
Salvage Regimen ◽  
Short Term Mortality ◽  
Short And Long Term ◽  
The Impact

Abstract Background SOT recipients are an ideal population in which to study the impact of new antibiotics, since they are particularly dependent upon drug activity to clear infections. In 3/15, FDA approved CAZ-AVI, the first new anti-CRE agent to arrive in the clinic. Our objective was to determine whether CAZ-AVI improves short- and long-term outcomes of CRE-infected SOT recipients. Methods We performed a retrospective study of SOT recipients infected with CRE since 2012, who were treated with CAZ-AVI or salvage agents for ≥ 3 days. Results 35 CRE-infected SOT recipients (14 liver, 11 lung, 6 kidney, 3 intestine, 1 heart) with bacteremia (20), pneumonia (11), intra-abdominal abscess (3) and soft-tissue infection/osteomyelitis (1) were enrolled. 16 and 19 patients (pts) were treated with CAZ-AVI and salvage agents, respectively. Types of infection or SOT, APACHE II and McCabe scores did not differ significantly between patients treated with CAZ-AVI or salvage agents. 30- and 90-d mortality rates were significantly lower among SOT recipients treated with CAZ-AVI (0% and 6%, respectively) compared with salvage agents (26% and 37%; P = 0.049 and 0.047). Among patients who survived 90 days, recurrent CRE infections were diagnosed in 53% and 17% of those treated with CAZ-AVI and a salvage regimen, respectively (P = 0.10). Median time from end of therapy for the 1st CRE infection to recurrent infection was 116 days (max 1,242) and 361 days (max 799) for CAZ-AVI and salvage regimens, respectively. Survival and recurrence-free survival were greater for treatment with CAZ-AVI and salvage agents, respectively, as measured by Kaplan–Meier (Figures). CAZ-AVI resistance developed in 37% (n = 3) of patients with recurrent infections. Recurrent isolates were genetically indistinguishable from parent isolates by core genome SNP phylogeny (< 15 SNP). Conclusion CAZ-AVI significantly reduced short-term mortality among SOT recipients with CRE infections compared with salvage regimens, but was limited by recurrent infections and emergence of resistance. The same strains caused recurrent and initial infections, suggesting that CAZ-AVI did not eliminate CRE from GI sites that serve as sources of recurrence. Optimizing outcomes in SOT recipients with CRE infections will require new agents like CAZ-AVI, and strategies to eliminate long-term colonization. Disclosures All authors: No reported disclosures.

scholarly journals Bariatric surgery proves long-term benefit in patients with cirrhosis

2020 ◽  
Author(s):  
Manhal Izzy ◽  
Mounika Angirekula ◽  
Barham K Abu Dayyeh ◽  
Fateh Bazerbachi ◽  
Kymberly D Watt
Keyword(s):  
Bariatric Surgery ◽  
Weight Loss ◽  
Descriptive Analysis ◽  
Total Body Weight ◽  
Hepatitis C Infection ◽  
Long Term Outcomes ◽  
Hepatic Decompensation ◽  
Compensated Cirrhosis

Abstract Background Obesity is commonly observed in patients with cirrhosis, especially with the increasing prevalence of non-alcoholic steatohepatitis (NASH). Bariatric surgery has been avoided in these patients given concerns about increased perioperative risk; therefore, data are lacking regarding long-term outcomes. In this study, we aimed to evaluate the long-term outcomes of patients with cirrhosis who underwent bariatric surgery. Methods We reviewed the charts of adult patients with compensated cirrhosis who underwent bariatric surgery after they were prospectively enrolled between February 23, 2009 and November 9, 2011, and followed in a pilot study for evaluation of bariatric surgery outcomes. Only patients with more than 4 years of follow-up were included in the analysis. Data regarding their liver disease, metabolic status, and survival were collected. A descriptive analysis was performed. Results The cohort consisted of 10 patients, of whom 7 were females. The median post-surgical follow-up was 8.7 years (± 1.4 years). All patients had biopsy-proven NASH; two patients had concurrent, untreated hepatitis C infection. During the observation period, there was a mean weight loss of 24 kg (19.2% of total body weight pre surgery, P &lt; 0.001) and only one patient regained weight to the baseline pre-surgical measurement. One patient who was not eligible for transplant developed hepatic encephalopathy 3 years after surgery and later died. The remainder of the patients did not have any hepatic decompensation, cardiovascular event, or mortality. Except for one patient with Gilbert syndrome, bilirubin was normal in all patients at last follow-up. Conclusions Bariatric surgery in patients with compensated cirrhosis can lead to sustained weight loss and stable hepatic function on long-term follow-up.

scholarly journals Management of Postoperative Discitis: A Study On 20 Cases of Prolapsed Lumber Intervertebral Disc (PLID) Operation In A Tertiary Level Hospital in Bangladesh

2015 ◽  
Vol 23 (2) ◽  
pp. 186-190
Author(s):  
Sukriti Das ◽  
Ehsan Mahmood ◽  
Md Jahangir Alam ◽  
Md Mamunur Rashid ◽  
Pijush Kumar Mitra
Keyword(s):  
Intervertebral Disc ◽  
High Index ◽  
Operative Intervention ◽  
Tertiary Level ◽  
Long Term Outcomes ◽  
Medical College ◽  
Specific Protocol ◽  
High Index Of Suspicion ◽  
Level Hospital

Context: The incidence of postoperative discitis is relatively uncommon. The paucity of physical examination findings with a high index of suspicion in any patient presenting with increasing back pain after prolapsed lumber intervertebral disc (PLID) operation gives clue of diagnosis.Purpose: To see the incidence, pathophysiology, laboratory markers and imaging finding of postoperative discitis, at the same time recommendation on treatment strategies with long term clinical outcome of discitis patient in Dhaka Medical College Hospital (DMCH), a tertiary level hospital in Dhaka, Bangladesh.Methods: In this observational study, 20 patients were recruited who underwent PLID operation in the Department of Neurosurgery, DMCH, Dhaka, from January 2012 to June 2014. After preliminary selection of patients a specific protocol was followed, by taking history, clinical examination, biochemical parameters and neuroimaging. Result of treatment was observed on the basis of symptomatic improvement, with laboratory and imaging findings.Results: The most common etiological agent is staphylococcus aureus. The C-reactive protein is the most sensitive clinical laboratory marker to assess the presence of infection and effectiveness of treatment response. MRI is the imaging modality of choice in the diagnosis of discitis (100%). The majority of patients are managed adequately with culture specific antibiotics and immobilization with good long term outcomes (75%). Operative intervention in those patients who fails to respond to medical treatment (25%).Conclusion: Postoperative discitis is a rare complication after PLID operation. Its diagnosis needs high index of suspicion, appropriate laboratory and imaging studies helps in diagnosis. In the majority of patients antibiotics and spinal immobilization has been shown to produce good long term outcomes. Operative intervention is rarely necessary in patients failing conservative treatment.J Dhaka Medical College, Vol. 23, No.2, October, 2014, Page 186-190

scholarly journals Evaluation of long-term clinical and health service outcomes following coronary artery revascularisation in Western Australia (WACARP): a population-based cohort study protocol

BMJ Open ◽  
2014 ◽  
Vol 4 (10) ◽  
pp. e006337 ◽  
Author(s):  
C Gardner ◽  
J M Rankin ◽  
E Geelhoed ◽  
M Nguyen ◽  
M Newman ◽  
...  
Keyword(s):  
Cohort Study ◽  
Cost Effectiveness ◽  
Coronary Artery ◽  
Western Australia ◽  
Long Term Outcomes ◽  
Individual Level ◽  
Population Cohort ◽  
Coronary Artery Revascularisation

IntroductionCoronary artery bypass grafting (CABG) and percutaneous coronary interventions (PCI) are procedures commonly performed on patients with significant obstructive coronary artery disease to relieve symptoms of ischaemia, improve survival or both. Although the efficacy of both procedures at the individual level has been established, the impact of advances in coronary artery revascularisation procedures (CARP) on long-term outcomes and cost-effectiveness at the population level are yet to be assessed. Our aim is to evaluate a minimum of 6-year outcomes and costs for the total population of patients who had CARP in Western Australia (WA) in 2000–2005.Methods and analysisThis retrospective population cohort study will link clinical and administrative health data for a previously defined cohort including all patients in WA who had a CARP in the period 2000–2005. The cohort consists of 19 014 patients who had 21 175 procedures (15 429 PCI and 5746 CABG). We are now collecting a minimum of 6 years follow-up of morbidity and mortality data for the cohort using the WA Data Linkage System, clinical registries and hospital records, with 12 years follow-up for cases in the year 2000. Comparison of long-term outcomes for different CARP will be reported (PCI vs CABG; bare metal stents vs drug-eluting stents vs CABG). Cost-effectiveness analysis of CARP from the perspective of the healthcare sector will be performed using individual level cost data and average costs from Australian Refined Diagnosis Related Groups.Ethics and disseminationThis study has received ethics approval from the University of Western Australia, the Western Australian Department of Health and all participating hospitals. Being a large population cohort study, approval included a waiver of informed consent. All findings will be presented at local, national and international healthcare/academic conferences and published in peer-reviewed journals.

Traumatic Brain Injury: A Trauma Surgeon's Perspective

2012 ◽  
Vol 22 (3) ◽  
pp. 82-89
Author(s):  
Oscar D. Guillamondegui
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Multidisciplinary Approach ◽  
Trauma Team ◽  
The United States ◽  
Long Term Outcomes ◽  
Term Care ◽  
Injured Brain ◽  
The Moment

Traumatic brain injury (TBI) is a serious epidemic in the United States. It affects patients of all ages, race, and socioeconomic status (SES). The current care of these patients typically manifests after sequelae have been identified after discharge from the hospital, long after the inciting event. The purpose of this article is to introduce the concept of identification and management of the TBI patient from the moment of injury through long-term care as a multidisciplinary approach. By promoting an awareness of the issues that develop around the acutely injured brain and linking them to long-term outcomes, the trauma team can initiate care early to alter the effect on the patient, family, and community. Hopefully, by describing the care afforded at a trauma center and by a multidisciplinary team, we can bring a better understanding to the armamentarium of methods utilized to treat the difficult population of TBI patients.

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