ABSTRACT
The rapid emergence of antibioticresistant bacteria is a threat to global health particularly in the area of healthcareassociate pneumonia (HCAP) where there is high rate of mortality. In general, guidelines should serve as a framework that needs to be complemented by local antibiogram data due to multiple factors influencing the development of multidrugresistant (MDR) HCAP. Failure to administer prompt and appropriate empirical therapy would often result in a high mortality rate. Based on these concerns, the aim of the study was to evaluate the appropriate empirical use of antibiotic and risk factors of MDR HCAP based on local pathogen resistant pattern. This was a retrospective analysis on HCAP in critical care of a tertiarycare hospital with data fromJanuary 2016 to December 2018. Patients diagnosed with HCAP: hospitalassociated pneumonia (HAP) and ventilatorassociated pneumonia (VAP), with positive bacterial cultures were included into the study. Of the 269 patients and isolates included, 160 (59.5%) had MDR strains. The top causative pathogens isolated were Acinetobacter baumannii(n=104, 38.7%), Pseudomonas aeruginosa(n=66, 24.5%), Klebsiella spp(n==55, 20.4%), and Staphylococcus aureus(n=16, 5.9%). The incidence of inappropriate empirical antibiotic was significantly higher in patients with MDR HCAP (n=135, 84.4%) compared to those with nonMDR HCAP (n=34, 31.2%) (p < 0.001). Mortality was significantly higher in patients receiving inappropriate empirical therapy (n = 118, 72.4%) compared to those receiving appropriate empirical antibiotic (n = 36, 54.5%) (P = 0.009). The independent risk factors for MDR HCAP identified in this study were hypoalbuminemia (odds ratio [OR] 3.43, 95% confidence interval [CI] 1.08 –10.87, p = 0.036) and indwelling central venous catheter (OR 5.65, 95% CI 1.13 –28.18, p = 0.035). This work serves as a basis for a centerspecific guideline to improve antibiotic use among HCAP patients in intensive care setting.
ABSTRACT
Effectiveness of oral mucositis (OM) pain control with the current standard of care management was assessed usingclinician and self-reported scales in hematopoietic stem cell transplant (HSCT) patients. A prospective observationalstudy was performed using clinician-assessed [World Health Organization (WHO)] Oral Toxicity Scales and selfreported scales [Oral Mucositis Daily Questionnaires (OMDQ)]. A total of 23 HSCT patients were included in thestudy. There were 100 recorded days of OM using WHO scores, and 144 recorded days of OM using OMDQ. A totalof 14/23 (60.9%) patients experienced mucositis. The presence of OM was significantly associated with increase inactual body weight [t(21) = 2.15, p = 0.044], body surface area (BSA) [t(21) = 2.31, p = 0.031] and body mass index(BMI) [t(21) = 2.13, p = 0.044], longer hospital stays [t(21) = 2.45, p = 0.023], and busulphan-based regimens (χ = 4.32,p = 0.038). The degree of pain relief was significantly inversely correlated to both the degree of WHO graded OMseverity (ρ = −0.586; p < 0.001) and the severity of self-reported pain (ρ = −0.375; p < 0.001). Both WHO and OMDQsignificantly positively correlated in the clinical setting (p < 0.001). In conclusion, this study highlights the potentialadvantages of using patient self-reported scales in the local clinical setting. The use of the OMDQ self-reported scalescould lead to earlier changes in therapy and may prove useful in HSCT patients.
ABSTRACT
Effectiveness of oral mucositis (OM) pain control with the current standard of care management was assessed usingclinician and self-reported scales in hematopoietic stem cell transplant (HSCT) patients. A prospective observationalstudy was performed using clinician-assessed [World Health Organization (WHO)] Oral Toxicity Scales and selfreported scales [Oral Mucositis Daily Questionnaires (OMDQ)]. A total of 23 HSCT patients were included in thestudy. There were 100 recorded days of OM using WHO scores, and 144 recorded days of OM using OMDQ. A totalof 14/23 (60.9%) patients experienced mucositis. The presence of OM was significantly associated with increase inactual body weight [t(21) = 2.15, p = 0.044], body surface area (BSA) [t(21) = 2.31, p = 0.031] and body mass index(BMI) [t(21) = 2.13, p = 0.044], longer hospital stays [t(21) = 2.45, p = 0.023], and busulphan-based regimens (χ = 4.32,p = 0.038). The degree of pain relief was significantly inversely correlated to both the degree of WHO graded OMseverity (ρ = −0.586; p < 0.001) and the severity of self-reported pain (ρ = −0.375; p < 0.001). Both WHO and OMDQsignificantly positively correlated in the clinical setting (p < 0.001). In conclusion, this study highlights the potentialadvantages of using patient self-reported scales in the local clinical setting. The use of the OMDQ self-reported scalescould lead to earlier changes in therapy and may prove useful in HSCT patients.
ABSTRACT
ABSTRACT This study was designed to evaluate utilization patterns and clinical outcome of intravenous immunoglobulin (IVIG) therapy among pediatric patients in a tertiary hospital. Demographic data, IVIG prescribed, and clinical outcome were retrospectively reviewed from the pharmacy dispensing data and patient medical records between 2007 and 2014. One hundred and fifteen instances of IVIG administration to 108 pediatric patients were recorded. A total of 61 cases (53%) and 54 cases (47%) of the IVIG administered were for labeled and off-labeled indications, respectively. Age, weight, specialty, total IVIG usage, length of hospital stays, and mortality rate were found to be significantly associated with the indication being labeled or off-labeled (p<0.05). However, there was no significant difference in terms of adverse reactions between labeled and off-labeled indications (p>0.05). Guidelines should be developed and implemented for rational and evidence-based use of IVIG to avoid unnecessary wastage.