Pneumonia is a leading cause of death in medical intensive care units (MICUs). Delayed or inappropriate antibiotic therapy largely increases morbidity and mortality. Multidrug-resistant (MDR) micro-organisms are major reasons for inappropriate antibiotic use. Currently there is no good antibiotic decision-making tool designed for critically ill patients. The objective of this study was to develop a convenient MDR prediction scoring system for patients admitted to MICUs with pneumonia. A retrospective cohort study was conducted using databases and chart reviews of pneumonia patients admitted to a 30-bed MICU from 2012 to 2013. Forward logistic regression was applied to identify independent MDR risk factors for prediction tool development. A total of 283 pneumonia episodes from 263 patients with positive cultures from blood or respiratory secretions were recruited, of which 154 (54.4%) were MDR episodes. Long-term ventilation (OR = 11.09; P = 0.026), residence in a long-term care facility (OR = 2.50; P = 0.005), MDR infection/colonisation during the preceding 90 days (OR = 2.08; P = 0.041), current hospitalisation ≥2 days (OR = 1.98; P = 0.019) and stroke (OR = 1.81; P = 0.035) were identified as independent predictors for MDR pneumonia. The area under the ROC curve of this prediction tool was much higher than that of ATS/IDSA classification (0.69 vs. 0.54; P <0.001). The prediction accuracy of this tool with risk score ≥1 for MDR infections was 63.7%. This simple five-item, one-step scoring tool for critically ill patients admitted to the MICU could help physicians provide timely appropriate empirical antibiotics.
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http://dx.doi.org/10.1016/j.ijantimicag.2016.05.013 | DOI Listing |
J Arthroplasty
December 2024
Centre for Orthopaedic and Trauma Research, The University of Adelaide, Australia.
Introduction: Periprosthetic joint infection (PJI) is a devastating and severe complication of total knee arthroplasty (TKA). The Australian Joint Registry reports an increasing number of debridement, antibiotics, and implant retention (DAIR) procedures, underscoring the need to comprehend outcomes for informed treatment decisions. This study aimed to determine outcome of DAIR procedures, evaluate time since primary TKA, and identify patient-related factors associated with DAIR failure.
View Article and Find Full Text PDFBMC Med Educ
December 2024
Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Background: Acute respiratory infections are a common presentation in clinical practice and medical interns must learn proper diagnosis and antibiotic prescribing. Traditional lecture-based teaching may not provide sufficient opportunities for students to apply their knowledge in realistic scenarios, whereas computer case-based simulations offer an alternative approach that allows active learning and decision-making in simulated patient cases. This study investigated the effectiveness of computer case-based reasoning simulation versus traditional lectures for medical interns teaching of diagnosis and antibiotic prescribing for acute respiratory infections.
View Article and Find Full Text PDFBackground: Tuberculosis program effectiveness is majorly measured by disease severity and treatment response without integrating patient perspectives. Yet, it's a critical dimension in clinical decision-making that enhances health worker-patient interactions and increases individuals' sustained engagement with treatment, thereby benefiting the people affected and the wider public by mitigating the infection risk. This study assessed the lived experiences of persons affected by tuberculosis who were on treatment in Nairobi County, Kenya.
View Article and Find Full Text PDFBMC Med Inform Decis Mak
December 2024
Information, Decision Enhancement and Analytics Center of Innovation, Salt Lake City Veterans Affairs, Salt Lake City, UT, USA.
Background: This study sought to understand the process of clinical decision-making for suspected pneumonia by emergency departments (ED) providers in Veterans Affairs (VA) Medical Centers. The long-term goal of this work is to create clinical decision support tools to reduce unwarranted variation in diagnosis and treatment of suspected pneumonia.
Methods: Semi-structured qualitative interviews were conducted with 16 ED clinicians from 9 VA facilities demonstrating variation in antibiotic and hospitalization decisions.
BMC Public Health
December 2024
Department of Veterinary Sciences, University of Turin, Grugliasco, TO, Italy.
Antimicrobials are extensively used in livestock to treat common diseases, including mastitis and other bacterial infections, with around 80% of food-producing animals receiving such treatments. Despite a ban in the EU since 2006, antibiotics are still used globally for growth promotion, exacerbating antimicrobial resistance (AMR). From the consumers' point of view, the potential exposure to resistant zoonotic bacteria in animal-derived food products may represent a threat to public health.
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