Risk factors associated with the development of seizures among adult patients treated with ertapenem: A matched case-control study.

OBJECTIVE: The purpose of this study is to compare the characteristics of those ertapenem-treated adult patients with and without development of seizures, and identify the associated factors for the development of seizures. METHODS: This retrospective study was conducted at Chia-Yi Christian Hospital from January 2012 to December 2014. Patients developing seizures during their ertapenem treatment course were identified as case patients. Those without seizures who had received ertapenem for at least five days were considered as the pool of control patients. For each case patient, four matched patients from the control pool were randomly selected as the final control group, based on age, gender, and the date of ertapenem prescription. RESULTS: A total of 1706 ertapenem-treated patients were identified, 33 (1.9%) individuals developed seizures with the enrollment of 132 matched control patients. Among these 33 patients, the average age was 79.3 ± 7.5 years, and 20 (60.6%) were male. The mean Charlson co-morbidity score was 4.5 ± 2.4, and the first episode of seizure happened 3.3 ± 2.6 days after receiving ertapenem. In multivariate logistic regression analysis, the independent predictors associated with the development of ertapenem-associated seizures were old stroke (OR, 14.36; 95% CI, 4.38-47.02; p < 0.0001), undergoing brain images within one year prior to the admission (OR, 5.73; 95% CI, 1.78-18.43; p = 0.0034), low hemoglobin level (OR, 3.88; 95% CI, 1.28-12.75; p = 0.0165) and low platelet count (OR, 4,94; 95% CI, 1.56-15.68; p = 0.0067) at presentations, and protective factors against the development of seizures were heart failure (OR, 0.04; 95% CI, 0.00-0.63; p = 0.0222), concomitant use of steroids (OR, 0.19; 95% CI, 0.05-0.77; p = 0.0201), or antiplatelet agents (OR, 0.12; 95% CI, 0.02-0.63, p = 0.0123) with ertapenem. CONCLUSIONS: The development of ertapenem-associated seizures may occur more frequently and much earlier due to its widespread use in treating drug-resistant pathogens, especially when these pathogens emerged worldwide.Our study would help physician to estimate the risk of developing seizure among patients receiving ertapenem.

Self-determined motivation and exercise behaviour in COPD patients.

The purpose of this study was to evaluate the self-determined motivation predictors of exercise behaviour following pulmonary rehabilitation in COPD recipients. This cross-sectional study was conducted with 135 COPD patients. A demographic questionnaire, clinical factors, behavioural regulations in exercise questionnaire, and leisure time exercise questionnaire were used to collect data. A logistic regression model was used to identify the predictors associated with demographics and self-determined motivation types regarding physical activity. Education level, episodes of acute exacerbation within 2 years, and identified regulation were significant predictors of executing physical activities with high metabolic equivalents. The results of this study imply that healthcare providers need to be aware of the importance of exercise motivation among COPD patients.

Salmonella enterica subspecies arizonae infection of adult patients in Southern Taiwan: a case series in a non-endemic area and literature review.

BACKGROUND: The majority of Salmonella arizonae human infections have been reported in southwestern United States, where rattlesnake-based products are commonly used to treat illness; however, little is known in non-endemic areas. We reviewed and analyzed the clinical manifestations and treatment outcomes in adult patients with S. arizonae infection at our institution. METHOD: A retrospective study was conducted at a regional teaching hospital in southern Taiwan from July 2007 to June 2014. All adult patients diagnosed with S. arizonae infections and treated for at least three days at Chia-Yi Christian Hospital were included. Patients were followed till discharge. RESULTS: A total of 18 patients with S. arizonae infections (median age: 63.5 years) were enrolled for analysis, of whom two thirds were male. The three leading underlying diseases were diabetes mellitus, peptic ulcer disease and malignancy. Ten patients had bacteraemia and the most common infection focus was the lower respiratory tract. Most of the patients (72.2%) received third-generation cephalosporins as definitive therapy. In contrast, ampicillin-based regimens (accounting for 45.2%) were the major treatment modalities in previous reports. The crude in-hospital mortality was 5.6%, which was much lower than what was previously reported (22.7%). CONCLUSIONS: Though uncommon, there were cases of S. arizonae infections in Taiwan. Patients receiving third-generation cephalosporins treatment had better prognosis compared with those treated with ampicillin-based regimen.