RESUMEN
Among hospitalized adults who received vancomycin for their skin and skin structure infection (SSSI), patients who experienced acute kidney injury (AKI) had considerably higher 30-day readmission rates. Nearly half of the observed 30-day readmissions were due to non-SSSI-related reasons, which is consistent with the persistent organ dysfunction observed among patients with AKI.
Asunto(s)
Lesión Renal Aguda , Veteranos , Lesión Renal Aguda/inducido químicamente , Lesión Renal Aguda/tratamiento farmacológico , Adulto , Antibacterianos/efectos adversos , Humanos , Incidencia , Readmisión del Paciente , Estudios Retrospectivos , Factores de Riesgo , Vancomicina/efectos adversosRESUMEN
STUDY OBJECTIVE: The objectives of this study were to (i) quantify the incidence of three concerning fluoroquinolone adverse events of interest (FQAEI, i.e., adverse tendon event (TE), clostridioides difficile infection (CDI), and aortic aneurysm/dissection (AAD)), (ii) identify the patient-level factors that predict these events, and (iii) develop clinical risk scores to estimate the predicted probabilities of each FQAEI based on patient-level covariates available on clinical presentation. DESIGN: Retrospective cohort study. SETTING: Upstate New York Veterans' Healthcare Administration from 2011 to 2016. PATIENTS: Hospitalized patients with community-acquired pneumonia receiving care in the Upstate New York Veterans' Healthcare Administration from 2011 to 2016. INTERVENTION: N/A. MEASUREMENTS: The outcomes of interest for this study were the occurrence of TE, CDI, and AAD. We also evaluated a composite of these three outcomes, FQAEI. MAIN RESULTS: The study population consisted of 1071 patients. The overall incidence of FQAEI, TE, AAD, and CDI was 6.5%, 1.8%, 4.5%, and 0.3%, respectively. For each outcome evaluated, the probability of the event of interest was predicted by the presence of certain comorbidities, previous healthcare exposure, choice of specific FQ antibiotic, or therapy duration. Concomitant steroids, pneumonia in preceding 180 days, and creatinine clearance <30 mL/min predicted FQAEI. CONCLUSIONS: Individual frequencies of three important FQAEIs were quantified, and risk scores were developed to estimate the probabilities of experiencing these events to help clinicians individualize treatment decisions for patients and reduce the potential risks of select FQAEIs.
Asunto(s)
Aneurisma de la Aorta , Infecciones por Clostridium , Infecciones Comunitarias Adquiridas , Neumonía , Tendinopatía , Veteranos , Humanos , Fluoroquinolonas/efectos adversos , Estudios Retrospectivos , Antibacterianos/efectos adversos , Neumonía/inducido químicamente , Neumonía/epidemiología , Neumonía/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/epidemiología , Aneurisma de la Aorta/inducido químicamente , Aneurisma de la Aorta/epidemiología , Aneurisma de la Aorta/tratamiento farmacológico , Infecciones por Clostridium/tratamiento farmacológico , Infecciones por Clostridium/epidemiología , Tendinopatía/inducido químicamente , Tendinopatía/tratamiento farmacológicoRESUMEN
We report the complete genome sequence of a clinical isolate of Providencia stuartii strain CMC-4104, isolated from a splenic abscess. Oxford Nanopore Technologies (ONT) and Illumina sequencing reads were assembled using Geneious to generate a 4,504,925-bp circular chromosome containing multiple copies of the NDM-1 and PER-1 genes in a genomic resistance island.
RESUMEN
STUDY OBJECTIVES: This study sought to compare real-world effectiveness outcomes between hospitalized patients with Clostridioides difficile infections (CDIs) who received early-targeted fidaxomicin or oral vancomycin at two Veterans Affairs Medical Centers (VAMCs). DESIGN: A retrospective cohort study was performed among hospitalized patients at two VAMCs from January 2008 until July 2017. SETTING: Albany and Syracuse VAMCs. PATIENTS: Patients were included in this analysis if they were age ≥18 years; were hospitalized; had a CDI with a Hines Severity Score Index (SSI) ≥2; received oral vancomycin (January 2008-June 2014 at Albany or Syracuse VAMCs) or fidaxomicin (March 2012-July 2017 at Albany VAMC) within 5 days of positive CDI stool sample for ≥ 48 hours. INTERVENTION: Receipt of an oral vancomycin- or fidaxomicin-containing CDI regimen. MEASUREMENTS: The primary outcome was a composite of 30-day mortality and 60-day recurrence. MAIN RESULTS: The study included 54 oral vancomycin and 38 fidaxomicin recipients. The population was predominantly male (97.8%), and mean ± standard deviation age was 74.6 ± 11.1 years. The composite outcome was significantly different between fidaxomicin and vancomycin recipients (26.3% fidaxomicin vs. 51.9% vancomycin; odds ratio (OR): 0.33, 95% CI: 0.14-0.81, p = 0.01). This finding was maintained in the multivariate analysis after adjustment for confounders (adjusted OR: 0.25, 95% CI: 0.09-0.73, p = 0.01) CONCLUSIONS: This real-world effectiveness study suggests that use of fidaxomicin potentially results in better outcomes relative to oral vancomycin for initial treatment of hospitalized VAMC patients with CDIs.