The determinants of hospital mortality among patients with septic shock receiving appropriate initial antibiotic treatment*.

Objective: To identify the determinants of hospital mortality among patients with septic shock receiving appropriate initial antibiotic treatment.

Design: A retrospective cohort study of hospitalized patients with blood culture positive septic shock (January 2002-December 2007).

Setting: Barnes-Jewish Hospital, a 1,250-bed urban teaching hospital.

Healthcare-associated pneumonia: approach to management.

Healthcare-associated pneumonia patients have worse outcomes and a different microbiologic profile than those with community-acquired pneumonia, including a greater risk for multidrug-resistant (MDR) organism infection. Risks include hospitalization for 2 or more days within 90 days, presentation from a nursing home or long-term care facility, attending a hospital or hemodialysis clinic, receiving intravenous therapy within 30 days, and immunosuppression. Ability to predict infection with MDR organisms varies, and the relative frequency of MDR organisms varies by geographic region.

Implementation of a real-time computerized sepsis alert in nonintensive care unit patients.

Objective: Early therapy of sepsis involving fluid resuscitation and antibiotic administration has been shown to improve patient outcomes. A proactive tool to identify patients at risk for developing sepsis may decrease time to interventions and improve patient outcomes. The objective of this study was to evaluate whether the implementation of an automated sepsis screening and alert system facilitated early appropriate interventions.

Inappropriate empiric antifungal therapy for candidemia in the ICU and hospital resource utilization: a retrospective cohort study.

Background: Candida represents the most common cause of invasive fungal disease, and candidal blood stream infections (CBSI) are prevalent in the ICU. Inappropriate antifungal therapy (IAT) is known to increase a patient's risk for death. We hypothesized that in an ICU cohort it would also adversely affect resource utilization.

Hospital resource utilization and costs of inappropriate treatment of candidemia.

Study Objectives: To evaluate the impact of inappropriate therapy--defined as delayed antifungal therapy beyond 24 hours from culture collection, inadequate antifungal dosage, or administration of an antifungal to which an isolate was considered resistant--on postculture hospital length of stay and costs, and to evaluate the relationship between modifiable risk factors, including failure to remove a central venous catheter, antifungal delay, and inadequate dosage, for an additive effect on hospital length of stay and costs.

Design: Single-center retrospective cohort study.

Setting: 1250-bed academic medical center.

A comparison of culture-positive and culture-negative health-care-associated pneumonia.

Objective: The aim of this study is to describe the initial antibiotic treatment regimens, severity of illness, and in-hospital mortality among culture-negative (CN) and culture-positive (CP) patients with health-care-associated pneumonia (HCAP).

Methods: We used a retrospective cohort study, examining adult patients with HCAP from Barnes-Jewish Hospital, a 1,200-bed urban teaching hospital.

Results: Eight hundred seventy patients with HCAP were identified over a 3-year period (January 2003 through December 2005) of whom 431 (49.

Treatment-related risk factors for hospital mortality in Candida bloodstream infections.

Objective: To examine the relationship between treatment-related variables for Candida bloodstream infection and hospital mortality.

Design: Retrospective cohort analysis.

Setting: Thousand two hundred-bed academic medical center.