Use Of Antibiotics In Patients Research Articles

Atrial fibrillation-related complications following short-term use of antibiotics in patients receiving NOAC or warfarin

Abstract Introduction To study the association of antibiotics with ischaemic stroke/systemic embolism (IS/SE) in patients with atrial fibrillation (AF) receiving anticoagulants. Methods This retrospective population-based cohort study applied electronic health data from a territory-wide medical database. Data were collected for patients with AF who were prescribed non-vitamin K antagonist oral anticoagulants (NOAC) or warfarin between Jan 1, 2010 and Dec 31, 2018. We further identify the patients with and without use antibiotics (any classification of antibiotics with prescription period within 7 days) during the NOAC/warfarin treatment period. The primary outcome is IS/SE and the secondary outcomes including hemorrhagic stroke (HS) and all-cause mortality. Patients were followed up for a median of 3.7 years. A self-control case crossover design was adopted to compare the short-term association between use of antibiotics and outcomes of interest among NOAC and warfarin group. Results This study included 40221 patients, consisted of 30617 NOAC users and 9826 warfarin users, while 9604 patients in NOAC group and 3325 patients in warfarin group had concurrent antibiotics use. At baseline, 46.1% of patients in NOAC group were male and the mean (SD) age was 77.4 (9.8) years, and 56.2% of patients in warfarin group were male and the mean (SD) age was 73.8 (11.3) years. Short-term use of antibiotics is associated with increased risk of IS/SE, HS and all-cause mortality in both NOAC and warfarin groups (NOAC vs. warfarin group: IS/SE: hazard ratio [HR]:3.41 [95%CI, 2.78-4.18]; HR: 2.51 [95%CI, 2.00-3.14]; HS: HR: 2.22 [95%CI, 1.78-2.78]; HR: 2.53 [95%CI, 1.86-3.43]; mortality: HR: 1.96 [95%CI, 1.85-2.08]; HR: 1.87 [95%CI, 1.73-2.02]; all P < 0.001). Conclusion The findings of the present study suggest that the short-term antibiotics use was associated with an increased risk of IS/SE, HS and all-cause mortality among patients in both NOAC and warfarin group. These findings further suggest that use of antibiotics may indicate a higher risk of IS/SE, HS and death for patients with AF, even when receiving NOAC/warfarin and that further investigation is warranted.The study design.The odds ratios of different outcomes.

Epidemiology of bronchiectasis at a single center in Japan: a retrospective cohort study

BackgroundThe characteristics of bronchiectasis (BE) in Asia, including Japan, remain largely unknown. We aimed to provide insights into the clinical characteristics and treatment outcomes of BE, especially regarding nontuberculous mycobacteria (NTM) infection and its poorly understood impact on prognosis. We also aimed to clarify the effect of long-term macrolide antibiotic use in patients with BE, who had no history of exacerbations.MethodsIn this single-center, retrospective study, the medical records of patients who satisfied the BE criteria between January 1, 2012, and August 31, 2023, were reviewed. Severe exacerbations and mortality during the observation period were recorded. Baseline characteristics and overall survival of patients with and without NTM infection, and factors influencing the time to the first exacerbation and death were analyzed. Additionally, the effects of long-term macrolide antibiotic use in patients without a history of severe exacerbations were estimated.ResultsIn a cohort of 1044 patients with BE, the rate of severe exacerbation was 22.3%, with mortality rates of 3.2% over 3 years. Notably, the high prevalence of NTM infection (n = 410, 39.3%) in this cohort was distinctive. NTM infection was not associated with either the time to first severe exacerbation (p = 0.5676, adjusted hazard ratio = 1.11) or mortality (p = 0.4139, adjusted hazard ratio = 0.78). Compared with the NTM group, the non-NTM group had a higher proportion of elevated inflammatory markers, with significant differences in C-reactive protein levels (p = 0.0301) and blood neutrophil counts (p = 0.0273). Pseudomonas aeruginosa colonization was more frequent in the non-NTM group (p = 0.0003). Among patients with non-NTM infection and without a history of exacerbation in the past 2 years, 38.2% received long-term macrolide antibiotics that did not invariably prolong the time to first severe exacerbation (p = 0.4517, IPW p = 0.3555).ConclusionsThis study highlights BE epidemiology in Japan, noting that the presence of NTM infection may not necessarily worsen the prognostic outcomes and advising caution in the casual use of macrolides for milder cases without a history of exacerbations.Clinical trial registrationUMIN Clinical Trials Registry Number: UMIN000054726 (Registered on 21 June 2024).

Demographic Factors Associated with Antibiotic Use for Patients Undergoing Extraction of Primary Teeth in the Emergency Department

Demographic Factors Associated with Antibiotic Use for Patients Undergoing Extraction of Primary Teeth in the Emergency Department

Characteristics of different pathogenic bacterial infections and their effects on prognosis in adult patients with bronchiectasis.

The present study aimed to analyse the types of pathogens infecting adults with bronchiectasis and the effects of different pathogens on the number of acute exacerbations and the length of hospitalization for 1 year in patients with severe bronchiectasis. A total of 522 patients with bronchiectasis admitted to the Department of Respiratory and Critical Care Medicine at the Second Hospital of Jiaxing (Zhejiang, China) between January 2019 and December 2022 were retrospectively analysed. The patients were divided into a mild to moderate group and a severe group according to the bronchiectasis severity index criteria. The basic and clinical information of all the patients was collected. The patients were followed up for 1 year after the day when the sputum or alveolar lavage fluid samples tested positive for pathogens. The follow-up information included the exacerbation of cough symptoms, the number of hospitalizations and the number of days of antibiotic use in patients with bronchiectasis. A total of 522 patients with bronchiectasis were positive for pathogens, including 192 patients with Pseudomonas aeruginosa (P. aeruginosa; 36.8%), 60 patients with Klebsiella pneumoniae (K. pneumoniae; 11.5%), 48 patients with mixed pathogens (≥2 pathogens at the same time; 9.2%), 36 patients with Staphylococcus aureus (6.9%), 33 patients with Aspergillus fumigatus (6.3%), 30 patients with Haemophilus influenzae (5.7%), 15 patients with Acinetobacter baumannii (A. baumannii; 2.9%) and 108 patients with other pathogens (20.7%). Compared with patients with mild to moderate bronchiectasis, patients with severe bronchiectasis were more likely to have P. aeruginosa but less likely to have K. pneumoniae and other pathogens. The length of hospitalization and duration of antibiotic use in the severe group of patients with bronchiectasis caused by P. aeruginosa, A. fumigatus, or A. baumannii were significantly longer than those in the mild to moderate group. During the 1-year follow-up, the number of acute exacerbations and hospitalizations of patients with severe bronchiectasis caused by A. baumannii and P. aeruginosa were significantly greater than those of patients with severe bronchiectasis caused by other pathogens. According to logistic regression analysis, A. baumannii and P. aeruginosa were independent risk factors for acute exacerbation of severe bronchiectasis in the following year. In patients with severe bronchiectasis, the pathogens A. baumannii, P. aeruginosa and A. fumigatus were independent risk factors for future acute exacerbations and increased risk of hospitalization.

Antibiotic use in patients referred to the university department

Antibiotic use in patients referred to the university department

CLINICAL ASSESSMENT OF ANTIBIOTICS USED IN CHRONIC KIDNEY DISEASE: A LONGITUDINAL OBSERVATIONAL STUDY

Objective: The study was conducted to clinically evaluate the safety and efficacy of antibiotic drug consumption based on laboratory data, specifically White Blood Cells(WBC) and Glomerular Filtration Rate (GFR) before and after antibiotic use in patients with chronic kidney disease. Methods: This retro-prospective longitudinal study was conducted on 115 patients with Chronic Kidney Disease (CKD) based on 6 mo of data at a tertiary care teaching institute, Geetanjali Medical College and Hospital, in Udaipur, Rajasthan. Inclusion criteria were all the patients who were admitted in the nephrology department and were above 18 y, who were receiving antibiotics, and Creatine Clearance (CrCl) was ≤ 60 ml/min were included into this study. Exclusion criteria patients with renal replacement and lacking information of laboratory data (WBC, CrCl) and those who were below the age of 18 were excluded from the study. The data were analysed using descriptive analysis. Results: The mean age of the CKD patients was 50.10 (standard deviation=17.47) y. Males were found in greater numbers than that of females with 66 (58%) and 49(42%) respectively. Patients admitted with stage 5 CKD (66%) were greater than the patients with stage 4 CKD. 10 different types of antibiotics were provided to CKD patients, of which seven had irrational doses. Piptaz, Meropenem, and Teicoplanin have the highest irrational doses incidence. Conclusion: Patients with CKD Stages 4 and 5 were given systemic antibiotics at unreasonable dosages, most frequently in the forms of piptaz, aztreonam, and meropenem injections. The incidence of irrational antibiotic dosages provided to the CKD patients was still high.

ROLE OF FUNGI IN COVID-19 PATIENTS WITH CHRONIC LUNG DISEASE IN RANI DURGAVATI MEDICAL COLLEGE, BANDA (FORMERLY GOVERNMENT ALLOPATHIC MEDICAL COLLEGE, BANDA 210001 (UP) INDIA.)

Background: Fungal infections of the lung have gained increasing recognition in the field of infectious disease and they are difficult to diagnosis. Advances in modern treatment like antibiotics corticosteroids, Immunosupressants and anticancer drugs have lead to increase in opportunistic fungal infections including bronchopulmonary Candidiasis and Bronchopulmonary aspergillosis has also increased, commonly occurs in COVID-19 patients of pre existing bronchial asthma. In India there is high prevalence of chronic lung diseases including bronchial Asthma, yet the diagnosis of aspergillosis and Candidiasis. An association between asthma and aspergillosis was noted and confirmed by isolation of Aspergillus species more commonly in sputum of Asthma patients (Lum et al., 2020 Singla, N. et al., 2019). Subject and Methods: To find out the role of fungi in 50 Corona virus (RTPCR test) positive patients of chronic lung disease (non tubercular) like COPD, Chronic Bronchitis with or without emphysema, Broncheichtasis, Bronchial Asthma were included. Patients were attended and admitted in Rani Durgavati Medical College (RDMC) and Hospital, Banda (UP) India, in a one year period was taken up from December 2020 till December 2021. The diagnosis of these cases v/as established by clinical features, radiological examination of chest, ECG, pulmonary function tests. Laboratory procedure for isolation and identification of fungi in bronchoalveoiar lavage. Each specimen of Bronchoalveloar Lavage (BAL) was subjected to various laboratory procedures for isolation and identification of fungi. Result: Different fungal species were cultured in 26% total cases. 20% isolates were positive for fungi alone whereas rest 6% cases showed both bacterial and fungal pathogens amongst fungi Candida was the predominant isolate in 16% cases followed by Aspergillus in 8% cases and Histopfasms capsulatum in just1(2%) case. Fungal isolates in bronchial aspirates were sensitive to Amphotericin B, Fluconazole, etc. Conclusion: COVID-19 Patients which are already containing chronic lung diseases especially COPD, bronchiectasis is more common in elderly males. The Bronchiectatic patients are also at risk of getting, fungal infections Patients of chronic lung disease who are on long-term antibiotic therapy, and or steroids are more predisposed to get these opportunistic infections. Another conclusion from it is clear that there is great need better and judicious use of antibiotics in patients to prevent drug resistance, to prevent further progression of the diseases.

Frequency of Group A Streptococcus Infection and Analysis of Antibiotic Use in Patients with Pharyngitis-A Retrospective, Multicenter Study.

Streptococcus pyogenes is responsible for 20-30% of pharyngitis in children and 5-15% in adults. The ineffective treatment of group A Streptococcus (GAS) infections can result in postinfectious sequelae. This study aims to evaluate the frequency of GAS pharyngitis and assess the management of patients with pharyngitis and antibiotic use. We conducted a multicenter, retrospective analysis of medical records from nine primary care centers in Poland. The study enrolled 1949 medical records of patients (children 67.4%, adults 32.6%). An infection of Streptococcus pyogenes, based on a rapid strep test, was diagnosed in 830 patients (42.6%). In the comprehensive study group of 1949 patients, 1054 (54.1%) were given antibiotics. Notably, 224 patients had a negative rapid strep test result but still received antibiotic treatment, underscoring the complexity of treatment decisions. The most commonly used antibiotics were oral penicillin V in 431 cases (41%) and amoxicillin in 219 cases (20.8%). We observed no significant difference between positive rapid strep test results and patients' sociodemographic data and comorbidities. The prevalence of GAS was 42.6% in the analyzed records of patients with pharyngitis, and 54.1% were prescribed antibiotics. Antibiotics were overprescribed for sore throats. Strategies are needed to promote rational antibiotic use.

Outcomes of patients hospitalized in ward settings for COVID-19 pneumonia with or without early empirical antibiotics.

During the first pandemic of COVID-19, early empirical antibiotic use rates for pneumonia varied widely. The benefit remains hypothetical. We assessed the benefit of empirical antibiotic use at admission in patients hospitalized with COVID-19 pneumonia. We enrolled all adults admitted from 1 March to 30 April 2020 with symptoms for ≤14 days, a positive nasopharyngeal PCR or a highly suggestive CT scan. The primary outcome was mortality at Day 28. The secondary outcomes were transfer to the ICU, mechanical ventilation and length of hospital stay. To handle confounding-by-indication bias, we used a propensity score analysis, expressing the outcomes in the original and overlap weighted populations. Among 616 analysed patients, 402 (65%) received antibiotics. At Day 28, 102 patients (17%) had died, 90 (15%) had been transferred to the ICU and 24 (4%) had required mechanical ventilation. Mortality in patients who received antibiotics was higher before but not after weighting (OR 2.7, 95% CI 1.5-5.0, P < 0.001 and OR 1.4, 95% CI 0.8-2.5, P = 0.28, respectively. Antibiotic use had no benefit on: transfer to ICU before and after weighting (OR 1.3, 95% CI 0.8-2.3, P = 0.30 and OR 1.1, 95% CI 0.6-1.9, P = 0.78, respectively); mechanical ventilation before and after weighting (OR 0.5, 95% CI 0.2-1.1, P = 0.079 and OR 0.75, 95% CI 0.3-2.0, P = 0.55, respectively); and length of hospital stay before and after weighting (mean difference -0.02 ± 0.5 days, P = 0.97 and mean difference 0.54 ± 0.75 days, P = 0.48, respectively). We did not find any benefit of antibiotic use in patients hospitalized with COVID-19 pneumonia.

Outpatient use of antibiotics in uncomplicated diverticulitis decreases hospital admissions.

Recently, antibiotics use in uncomplicated acute diverticulitis (AD) has been controversial in Europe. The American Gastroenterological Association (AGA) in their 2015 guidelines recommend their selective use. Our study highlights their role in outpatient management. We queried the Diamond Network through TriNetX-Research Network including 92 healthcare organizations. We included large intestine diverticulitis without perforation, abscess or bleeding. Exclusion criteria included any of sepsis criteria, CRP > 15 mg/L, immunodeficiency or HIV, coronary artery disease, chronic kidney disease, history of Crohn's disease or ulcerative colitis, heart failure, hypertension, diabetes or any of the following in the 3 months before study date; clostridium difficile (C. diff) infection, diverticulitis or antibiotics. Patients with AD were divided into two cohorts; patients on antibiotics, and patients not on antibiotics. Cohorts were compared after propensity-score matching (PSM). 214,277 patients met inclusion criteria. 58.9% received antibiotics, and 41% did not. After PSM, both cohorts had 84,320. Rate of hospital admission was lower in the antibiotic group (3.3% vs 4.2%, p < .001). There was a statistical difference between ICU admission (0.1% vs 0.15%, p < .01) and the rate of bowel perforation, peritonitis, abscess formation or bleeding (1.3% vs 1.4%, p = .044). There was no difference in mortality (0.1% vs 0.1%, p = .11), C. diff (0.1% vs 0.1%, p = .9), colectomies (0.2% vs 0.2%, p = .33), or Acute Kidney Injury (AKI) (0.1% vs 0.1%, p = .28). Outpatient use of antibiotics in patients with uncomplicated AD is associated with lower rates of hospital admissions and complications without changing mortality rate or surgical intervention.

Antibiotics in inflammatory arthritis and background population one year before and after diagnosis: a nationwide drug utilisation study.

To describe antibiotic use in patients with inflammatory arthritis (IA) and in the background population (BP) within one year before and after IA diagnosis. Using data from Danish nationwide registries, we identified all adults with a first-time diagnosis of rheumatoid arthritis (RA), psoriatic arthritis (PsA), or ankylosing spondylitis/spondyloarthritis (AS/SpA) from 2010 through 2018. For each IA patient, we randomly sampled ten persons from the BP, matched on sex and birthdate. We calculated the prevalence (n [%]) of any antibiotic dispensing and the total antibiotic dispensing in the year before and after diagnosis. We identified 28 504 new-onset IA patients (RA, n = 16 130; PsA, n = 5,988; AS/SpA, n = 6,386) and 285 040 BP individuals. The one-year prevalence of any antibiotic dispensing was 42.1% in IA patients before diagnosis vs 30.7% in the BP. The total antibiotic dispensing was higher the one-year before both RA, PsA, and As/SpA compared with BP (prevalence rate ratios [PRR], 1.48 [1.46; 1.51]; 1.67 [1.62; 1.72]; 1.52 [1.47; 1.56], respectively), and increased with 22% in IA patients three months before diagnosis compared with the preceding three-month period. Although the prevalence of any antibiotic dispensing in IA patients decreased in the year following the diagnosis (IA; 40.6%), the total one-year antibiotic dispensing remained constant in RA (PRR 0.99 [0.97; 1.01]), decreased in PsA (0.91 [0.87; 0.94]), and increased in AS/SpA (1.08 [1.04; 1.12]) patients after diagnosis compared with before. Antibiotics are more frequently dispensed to individuals developing IA compared with the BP. Antibiotic utilisation patterns change after IA diagnosis with marked differences among IA subgroups.

Antibiotic use and risk of Clostridioides difficile infection in patients with inflammatory bowel disease.

Patients with inflammatory bowel disease (IBD) have an increased risk of Clostridioides difficile infection (CDI) compared with those without IBD, which is worsened with antibiotic usage. While prior studies have shown a correlation between CDI development and certain classes of antibiotics, the IBD population has not been well represented. This study evaluates the rates of CDI with outpatient antibiotic use in patients with IBD. We conducted a retrospective cohort study composed of patients with IBD and compared the incidence of CDI in patients who received an outpatient prescription for antibiotics (6694 patients) against those without prescriptions (6025 patients) from 2014 to 2020 at our institution. We compared CDI rates based on nine antibiotic classes: penicillins, cephalosporins, sulfonamides, tetracyclines, macrolides, quinolones, clindamycin, metronidazole, and nitrofurantoin. The risk of CDI was low (0.7%) but significantly higher for those with antibiotic exposure (0.9% vs 0.5%, P=0.005) and had a positive correlation with a smoking history. The increased risk of CDI in the IBD population was attributable to the clindamycin and metronidazole classes (odds ratio=4.7, 95% confidence interval: 1.9-11.9, P=0.001; odds ratio=3.6, 95% confidence interval: 2.1-6.2, P<0.0001, respectively). The use of clindamycin or metronidazole prescribed in an outpatient setting was associated with a statistically significant increased risk of CDI in patients with IBD. Although the association between clindamycin and CDI is a well-established and common finding, the association between metronidazole and CDI is unique in this study.

Procalcitonin level threshold and antibiotic use in patients receiving chimeric antigen receptor T-cell therapy

ABSTRACT Background: Patients undergoing chimeric antigen receptor (CAR) T-cell therapy are vulnerable to infection and sepsis. Treatment course is frequently complicated by cytokine release syndrome which is often clinically and biochemically indistinguishable from sepsis. Procalcitonin (PCT) levels have been examined as a promising biomarker for infection in this cohort of patients. Methods: In this study, we measured daily PCT levels for patients for fourteen days (or hospital discharge) after receiving CAR T-cells to determine threshold PCT values specific for infection compared to those without infection. Results: We present preliminary results of our enrolled cohort to date (sixteen patients). Infection was present in only 12.5% of patients. However, those diagnosed with sepsis had elevated PCT levels with a peak mean of 2.6 µg/L observed on the seventh day post-treatment compared to those without infection remaining below 0.5 µg/L. Furthermore, we observed a trend for early and liberal antibiotic administration within our cohort. Conclusion: Our study highlights the challenges of antimicrobial stewardship in managing CAR T-cell therapy recipients. Our preliminary results underscore the utility of PCT in the risk-stratification and diagnosis of those patients at high risk for infectious complications after receiving CAR T-cell therapy and continue to advocate for a PCT threshold of 1.5 µg/L for diagnosing sepsis. Additionally, in the setting of CRS and lymphodepletion, where white cell count and CRP value are unreliable, a PCT value of < 0.5 µg/L may help exclude sepsis.

Use of antibiotics in the early COVID-19 pandemic in Poland, the Netherlands and Spain, from erraticism to (more) logic

IntroductionIn the Spring of 2020, the world was hit with unparalleled impact by the coronavirus pandemic. Antibiotics were widely used, even without good rationale. The aim of our study was to compare the use of antibiotics in patients with confirmed COVID-19 from three hospitals across Europe (Poland, the Netherlands and Spain) between two subsequent periods in the early days of the pandemic.MethodWe analysed data (antibiotics used and variation in the use of antibiotics, patients, admission and disease-related characteristics) from 300 patients admitted in three hospitals (University Hospital in Cracow, University Medical Center in Utrecht and Vall d’Hebron University Hospital in Barcelona) with confirmed infection of SARS-CoV-2 during Q1 2020 and Q4 2020.ResultsThere was ample variation in terms of patient mix and outcomes across the 3 hospitals. The majority of patients (225 out of 300) in all 3 hospitals received at least 1 antibiotic during the hospitalisation period. A minority of patients (68 out of 300) had their bacterial test results positive during their hospitalisation period. Throughout the 2 study periods, third-generation cephalosporins (ceftriaxone in 170 out of 300 patients) emerged as the most commonly used class of antibiotics. There was an apparent shift towards more rational utilisation of antibiotics, in all three hospitals.ConclusionsOur study shows that during the early stage of COVID-19 pandemic in 2020, antibiotics were frequently used in three European teaching hospitals despite the relatively low incidence of microbiologically confirmed bacterial infections. While in the early days of the COVID-19 pandemic antibiotic prescribing was full of trial and error, we could also confirm a learning curve over time.

Antibiotic Use and Survival in Patients With Late-Stage NSCLC Treated With Chemoimmunotherapy

IntroductionImmunotherapy has improved survival in patients with advanced NSCLC. Efficacy may decrease when patients are treated with antibiotics, possibly due to gut microbiome disruption, but few studies have investigated this using real-world, patient-level populations in the United States. MethodsWe have analyzed antibiotic use in patients with stage IV first, primary NSCLC diagnosed in 2015 and treated with chemotherapy or chemoimmunotherapy, drawn from the Surveillance, Epidemiology, and End Results-Medicare data set. Patients had to have continuous part A, part B, and part D Medicare coverage. Survival was determined through Kaplan-Meier and Cox proportional hazards models. All data analyses were performed using SAS. ResultsThe study included 788 patients, 440 (56%) of whom received antibiotics within 2 months before or after starting systemic treatment. The median follow-up time was 11.64 months. There was a statistically significant difference in survival for patients who received antibiotics (p = 0.007) and who had more than 1 round of antibiotics versus zero or 1 round (p ≤ 0.0001). After adjustment, receipt of antibiotics (hazard ratio [HR]adj: 1.17, 95% confidence interval [CI]: 0.99–1.37) and receipt of multiple rounds of antibiotics (HRadj: 1.35, 95% CI: 1.14–1.60) were statistically significantly associated with worse survival. Among just those receiving chemoimmunotherapy (n = 203; 26%), there was still an increased risk of death for those receiving multiple antibiotic rounds (HRadj: 1.52, 95% CI: 1.09–2.13). ConclusionsAntibiotic use concurrent with chemoimmunotherapy seems to be associated with worse survival. This is more pronounced when more cycles of antibiotics are given. IRB approval numberSTUDY-19-00500.

Advancements in Topical and Systemic Antibiotic Management for Burn Wounds: A Comprehensive Literature Review

Introduction: Antimicrobial treatment in burn patient include systemic and topical antibiotic care should be carefully deliberated to prevent the development of resistant organisms Methods: This literature review was compiled using information from numerous open access web databases. Data were compiled and analyzed. Results and Discussions: To prevent antibiotic resistance and prevent infection, the best prophylactic antibiotics for burn patients are topical antibiotics. However, for the treatment of patients with extensive burns or those with antibiotic resistance, especially antibiotics for gram-positive bacteria, systemic antibiotics can be used for treatment. Conclusion: The use of antibiotics in patients with burns can be adjusted to the patient's needs. surgeons may consider its use to prevent antibiotic resistance in patients.

Laparoscopic cholecystectomy in calculous cholecystitis: are antibiotics necessary?

Laparoscopic cholecystectomy in patients with cholecystitis is considered the best, appropriate and safe method of treatment for gallstone disease. However, the role of antibiotic administration before or after cholecystectomy to reduce infectious complications, particularly surgical site infections, or mortality is less clear. Many patients receive empiric antibiotics, but the feasibility of their use has not been proven. Some guidelines suggest the use of antibiotic prophylaxis for all cholecystectomies, although current evidence does not indicate any benefit to this practice in the absence of risk factors. This review examines the results of antibiotic use in laparoscopic cholecystectomy for chronic and acute calculous cholecystitis. Most studies argue against the need to use prophylactic antibiotics during elective surgery in low-risk patients. In cases of mild and moderate acute cholecystitis, the use of antibiotics to prevent postoperative infectious complications has no evidence of effectiveness, although these recommendations are also ambiguous. It is not recommended to use postoperative antibiotics after elective laparoscopic cholecystectomy, as well as for mild or moderate acute cholecystitis. However, additional studies with well-defined patient populations and comparable outcomes are needed to better assess the most appropriate timing and duration of antibiotic use in patients undergoing laparoscopic cholecystectomy. We used MedLine database on the PubMed platform and the Cochrane library to search for literature sources.

Brensocatib in non-cystic fibrosis bronchiectasis: ASPEN protocol and baseline characteristics.

Brensocatib is an investigational, oral, reversible inhibitor of dipeptidyl peptidase-1 shown to prolong time to first exacerbation in adults with bronchiectasis. Outlined here are the clinical trial design, and baseline characteristics and treatment patterns of adult patients enrolled in the phase 3 ASPEN trial (NCT04594369). The ASPEN trial is a global study enrolling patients with a clinical history consistent with bronchiectasis (cough, chronic sputum production and/or recurrent respiratory infections), diagnosis confirmed radiologically and ≥2 exacerbations in the prior 12 months. It was designed to evaluate the impact of two brensocatib doses (10 mg and 25 mg) on exacerbation rate over a 52-week treatment period versus placebo. Comprehensive clinical data, including demographics, disease severity, lung function, Pseudomonas aeruginosa status and quality of life, were collected at baseline. 1682 adults from 35 countries were randomised from December 2020 to March 2023. Mean age was 61.3 years and 64.7% were female. ∼70% had moderate-to-severe Bronchiectasis Severity Index (BSI) scores, 29.3% had ≥3 exacerbations in the prior 12 months and 35.7% were positive for P. aeruginosa. Mean BSI scores were highest in Australia/New Zealand (8.3) and lowest in Latin America (5.9). Overall, the most common aetiology was idiopathic (58.4%). In P. aeruginosa-positive versus P. aeruginosa-negative patients, lung function was lower, with greater long-term macrolide (21.5% versus 14.0%) and inhaled corticosteroid use (63.5% versus 53.9%). There was wide regional variation in long-term antibiotic use in patients with bronchiectasis and P. aeruginosa. ASPEN baseline characteristics and treatment profiles were representative of a global bronchiectasis population.

Appropriateness of antibiotic prescribing for urinary tract infection in the emergency department of a tertiary care hospital

BackgroundUrinary tract infections (UTIs) are frequently diagnosed in the Emergency Departments (EDs) in Saudi Arabia. Despite their prevalence, there is a lack of localized data on antibiotic prescribing practices for UTIs in EDs, hampering optimal patient care and antibiotic resistance management. ObjectiveThis study aimed to evaluate the appropriateness of antibiotic prescriptions for UTI patients by examining adherence to treatment guidelines at a tertiary care ED in Saudi Arabia. MethodsA retrospective cohort analysis was performed in UTI patients with ≥18 years of age who were presented to the ED at a tertiary care hospital between January 2022 and January 2023. 179 patients were randomly selected for enrollment, and data related to their demographics, medical history, microbial isolation, administered antibiotics, and incidence of recurrent infections were collected. ResultsCiprofloxacin (38 %), Cefuroxime (26.8 %), and Nitrofurantoin (16.8 %) were the most prescribed antibiotics. The female population accounted for 87.3 % of UTI cases. Notably, 40.7 % lacked microbial growth or data. Inappropriateness was found in 55.3 % of selection, 27.9 % of dosing, and 38.5 % of treatment duration confined to antibiotics in UTI management. Moreover, complicated UTIs rather than duration and indication for antibiotic therapy were independent risk factors for the re-occurrence of UTIs. ConclusionsThe study depicted an overall 44.7 % of appropriate antibiotic prescriptions in UTI patients. However, it also highlighted the necessity for tailored interventions and promotional efforts aimed at promoting the rational use of antibiotics in patients, thereby preventing resistance and treatment failure.

Post-operative antibiotic prophylaxis in spine surgery patients with thoracolumbar drains: A meta analysis

Closed-suction drains are commonly placed after thoracolumbar surgery to reduce the risk of post-operative hematoma and neurologic deterioration, and may stay in place for a longer period of time if output remains high. Prolonged maintenance of surgical site drains, however, is associated with an increased risk of surgical site infection (SSI). The present study aims to examine the literature regarding extended duration (≥24h) prophylactic antibiotic use in patients undergoing posterior thoracolumbar surgery with closed-suction drainage. This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Relevant studies reporting the use of 24-h post-operative antibiotics compared with extended duration post-operative antibiotics in patients undergoing posterior thoracolumbar surgery with closed-suction drainage were identified from a PubMed database query. Six studies were included for statistical analysis, encompassing 1003 patients that received 24h of post-operative antibiotics and 984 patients that received ≥24h of post-operative antibiotics. The SSI rate was 5.16% for the shorter duration group (24h) and 4.44% (p=0.7865) for the longer duration group (≥24h). There is no significant difference in rates of SSI in patients receiving 24h of post-operative antibiotics compared with patients receiving ≥24h of post-operative antibiotics. Shorter durations of post-operative antibiotics in patients with thoracolumbar drains have similar outcomes compared to patients receiving longer courses of antibiotics. Shorter durations of antibiotics could potentially help lead to lower overall cost and length of stay for these patients.