A clinical prediction tool for extended-spectrum ß-lactamase-producing Enterobacteriaceae urinary tract infection.

BACKGROUND: Prevalence of extended-spectrum beta-lactamase-producing-Enterobacteriaceae (ESBL-E) has risen in patients with urinary tract infections. The objective of this study was to determine explore the risk factors of ESBL-E infection in hospitalized patients and establish a predictive model. METHODS: This retrospective study included all patients with an Enterobacteriaceae-positive urine sample at the first affiliated hospital of Jinan university from January 2018 to December 2019. Antimicrobial susceptibility patterns of ESBL-E were analyzed, and multivariate analysis of related factors was performed. From these, a nomogram was established to predict the possibility of ESBL-E infection. Simultaneously, susceptibility testing of a broad array of carbapenem antibiotics was performed on ESBL-E cultures to explore possible alternative treatment options. RESULTS: Of the total 874 patients with urinary tract infections (UTIs), 272 (31.1%) were ESBL-E positive. In the predictive analysis, five variables were identified as independent risk factors for ESBL-E infection: male gender (OR = 1.607, 95% CI 1.066-2.416), older age (OR = 4.100, 95% CI 1.678-12.343), a hospital stay in preceding 3 months (OR = 1.872, 95% CI 1.141-3.067), invasive urological procedure (OR = 1.810, 95% CI 1.197-2.729), and antibiotic use within the previous 3 months (OR = 1.833, 95% CI 1.055-3.188). In multivariate analysis, the data set was divided into a training set of 611 patients and a validation set of 263 patients The model developed to predict ESBL-E infection was effective, with the AuROC of 0.650 (95% CI 0.577-0.725). Among the antibiotics tested, several showed very high effectiveness against ESBL-E: amikacin (85.7%), carbapenems (83.8%), tigecycline (97.1%) and polymyxin (98.2%). CONCLUSIONS: The nomogram is useful for estimating a UTI patient's likelihood of infection with ESBL-E. It could improve clinical decision making and enable more efficient empirical treatment. Empirical treatment may be informed by the results of the antibiotic susceptibility testing.

Drug-related problems in hospitalised Parkinson's disease patients in China.

BACKGROUND: There has been a lack of studies on the types and severity of drug-related problems (DRPs) in hospitalised patients with Parkinson's disease (PD) in China until now. OBJECTIVE: To investigate the types and causes of DRPs, and to assess the severity of these DRPs in PD patients in neurology wards. METHODS: A retrospective study involving 209 PD inpatients was conducted at a tertiary hospital in China from January 2017 to December 2018. The identification and assessment of DRPs were based on the Pharmaceutical Care Network Europe (PCNE) tool version 8.03. The severity ratings of these DRPs was assessed based on the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) classification. RESULTS: A total of 274 DRPs with an average of 1.31±1.00 problems per patient were identified, in which 83.3% of the population had at least one DRP. Using the PCNE classification system, the most common domain of DRPs was "Other, P3" (62.8%), followed by "Treatment effectiveness, P1" (19.3%) and "Treatment safety, P2" (17.9%). A total of 88.7% of the DRPs were rated at severity categories B to D (causing no or potential harm), whereas 11.3% were rated as categories E to H (causing actual harm). CONCLUSIONS: These data indicate that the prevalence of DRPs is high among PD patients. The identification of different subtypes of DRPs may facilitate risk reduction for PD patients.