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1.
Eur J Clin Microbiol Infect Dis ; 37(2): 305-311, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29177611

RESUMO

The efficacy of empirical non-carbapenem antibiotics for extended-spectrum beta-lactamase-producing Enterobacteriaceae bacteremia (ESBL-B) is still inconclusive. We conducted a multicenter retrospective cohort study to evaluate the efficacy of empirical non-carbapenem antibiotics for treating ESBL-B. Electronic medical records of individuals who were diagnosed with ESBL-B were reviewed between January 2010 and December 2014 at four university hospitals in Korea. Patients were classified into non-carbapenem and carbapenem groups according to the empirical antibiotic regimen. Patients treated with appropriate empirical antibiotics and who subsequently received carbapenems as definitive therapy were included in the analysis. The inverse probability of treatment weights, a statistical method that adjusts baseline statistics by giving weights based on propensity score, was used. During the study period, 232 adequately treated patients with ESBL-B were included in the analysis: 49 patients in the non-carbapenem group and 183 in the carbapenem group. The baseline characteristics and severity of infection were similar after propensity score weighting. The 30-day mortality rates for the two groups were not statistically significantly different (non-carbapenems 6.3% and carbapenems 11.4%; P = 0.42). In a multivariate analysis, empirical treatment with non-carbapenem antibiotics was not associated with 30-day all-cause mortality (HR 1.02, 95% CI 0.99-1.06, P = 0.14). In a subgroup analysis, empirical treatment with piperacillin-tazobactam was also not associated with 30-day all-cause mortality (HR 1.21, 95% CI 0.37-4.00, P = 0.75). Appropriate non-carbapenems were not inferior to carbapenems as initial empirical therapy for ESBL-B.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Klebsiella/tratamento farmacológico , Pontuação de Propensão , Idoso , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Ciprofloxacina/uso terapêutico , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/microbiologia , Feminino , Humanos , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/isolamento & purificação , Masculino , Meropeném , Pessoa de Meia-Idade , Ácido Penicilânico/análogos & derivados , Ácido Penicilânico/uso terapêutico , Piperacilina/uso terapêutico , Combinação Piperacilina e Tazobactam , Estudos Retrospectivos , Centros de Atenção Terciária , Tienamicinas/uso terapêutico , Resultado do Tratamento
2.
Eur J Clin Microbiol Infect Dis ; 36(11): 2093-2100, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-28643188

RESUMO

Despite a significant increase of bloodstream infection caused by extended-spectrum-ß-lactamase (ESBL)-producing Enterobacteriaceae in the community-setting, information regarding clinical outcomes of inappropriate empiric therapy (IAT) in patients with those infections is limited. A multicenter-retrospective cohort study was conducted in four hospitals. A total of 249 adults were identified to have community-onset bacteremia caused by ESBL-producing Escherichia coli and Klebsiella pneumoniae, and definitively treated with carbapenems. According to the appropriateness of empiric therapy, individuals were divided into an appropriate empiric therapy (AT) group (n = 106) and IAT group (n = 143). Patients who received AT showed more severe underlying conditions including underlying solid cancer, healthcare-association and intensive care unit (ICU) care, compared to the IAT group. Primary bacteremia was more commonly found in the AT group than in the IAT group, while urinary tract infection predominated more frequently in the IAT group than in the AT group. Multivariate analysis using propensity score analysis indicated that inappropriateness of empiric therapy was not an independent risk factor for 30-day death. ICU care, respiratory tract infection and underlying liver, renal and connective tissue diseases were significantly associated with mortality. In patients with bloodstream infections caused by ESBL-producing E. coli and K. pneumoniae in the community-setting, delay in appropriate therapy was not associated with an increased rate of death if the patients were definitively treated with carbapenems.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Carbapenêmicos/uso terapêutico , Infecções por Escherichia coli/tratamento farmacológico , Prescrição Inadequada/efeitos adversos , Infecções por Klebsiella/tratamento farmacológico , Idoso , Bacteriemia/microbiologia , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Escherichia coli/efeitos dos fármacos , Escherichia coli/genética , Infecções por Escherichia coli/microbiologia , Feminino , Humanos , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/genética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resistência beta-Lactâmica/genética
3.
Eur J Surg Oncol ; 43(6): 994-1002, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-27546015

RESUMO

AIM: This study aimed to evaluate the surgical safety and clinical effectiveness of RH versus LH and laparotomy for cervical cancer. METHODS: We searched Ovid-Medline, Ovid-EMBASE, and the Cochrane library through May 2015, and checked references of relevant studies. We selected the comparative studies reported the surgical safety (overall; peri-operative; and post-operative complications; death within 30 days; and specific morbidities), and clinical effectiveness (survival; recurrence; length of stay [LOS]; estimated blood loss [EBL]; operative time [OT]) and patient-reported outcomes. RESULTS: Fifteen studies comparing RH with OH and 11 comparing RH with LH were identified. No significant differences were found in survival outcomes. The LOS was shorter and transfusion rate was lower with RH compared to OH or LH. EBL was significantly reduced with RH compared to OH. Compared to OH, overall complications, urinary infection, wound infection, and fever were significantly less frequent with RH. The overall, peri-operative, and post-operative complications were similar in other comparisons. Several patient-reported outcomes were improved with RH, though each outcome was reported in only one study. CONCLUSIONS: RH appears to have a positive effect in reducing overall complications, individual adverse events including wound infection, fever, urinary tract infection, transfusion, LOS, EBL, and time to diet than OH for cervical cancer patients. Compared to LH, the current evidence is not enough to clearly determine its clinical safety and effectiveness. Further rigorous prospective studies with long-term follow-up that overcome the many limitations of the current evidence are needed.


Assuntos
Adenocarcinoma/cirurgia , Carcinoma de Células Escamosas/cirurgia , Histerectomia/métodos , Laparoscopia/métodos , Recidiva Local de Neoplasia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/métodos , Neoplasias do Colo do Útero/cirurgia , Perda Sanguínea Cirúrgica , Feminino , Humanos , Laparotomia , Tempo de Internação , Duração da Cirurgia , Taxa de Sobrevida , Resultado do Tratamento
4.
Eur J Surg Oncol ; 42(9): 1303-14, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27439723

RESUMO

AIM: This study aimed to evaluate the surgical safety and clinical effectiveness of RH compared to OH and LH for endometrial cancer. METHODS: We searched Ovid-Medline, Ovid-EMBASE, and the Cochrane library for studies published through May 2015. The outcomes of interest included safety (overall; peri-operative and post-operative complications; death within 30-days; and specific morbidities), effectiveness (survival, recurrence, length of stay [LOS], estimated blood loss [EBL], and operative time [OT]), and patient-reported outcomes (pain score, pain medication use, length of pain medication use, and time to return to work). Two independent reviewers extracted data and assessed the risk of bias. RESULTS: Twenty-four studies comparing RH to OH and 24 comparing RH to LH were identified. No significant differences were found in survival outcomes. The LOS was shorter, there was less EBL, and the rates of complications, readmission, and transfusion were lower with RH compared to OH. However, RH showed a longer OT and a higher incidence of vaginal cuff dehiscence compared to those for OH. Compared to LH, the LOS was shorter, there was less EBL, and the rates of conversion to laparotomy, intra-operative complications, urinary tract injuries, and cystotomy were lower in RH. Several patient-reported outcomes showed a significant benefit of RH, but each outcome was reported in only one study. CONCLUSIONS: RH may be a generally safer and better option than OH and LH for patients with endometrial cancer. Further prospective studies with long-term follow-up are required.


Assuntos
Adenocarcinoma de Células Claras/cirurgia , Carcinoma Endometrioide/cirurgia , Neoplasias do Endométrio/cirurgia , Histerectomia/métodos , Neoplasias Císticas, Mucinosas e Serosas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Procedimentos Cirúrgicos Robóticos/métodos , Analgésicos/uso terapêutico , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Conversão para Cirurgia Aberta/estatística & dados numéricos , Intervalo Livre de Doença , Feminino , Humanos , Laparoscopia/métodos , Laparotomia , Tempo de Internação/estatística & dados numéricos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Medidas de Resultados Relatados pelo Paciente , Fatores de Tempo , Resultado do Tratamento
5.
Int J Tuberc Lung Dis ; 17(2): 153-62, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23317949

RESUMO

BACKGROUND: Exacerbations contribute substantially to the morbidity and mortality associated with chronic obstructive pulmonary disease (COPD). OBJECTIVES: To assess whether prophylactic antibiotic treatment reduces exacerbations in patients with COPD and/or chronic bronchitis. METHODS: Medline, EMBASE, Cochrane Central Register of Controlled Trials, Koreamed and references from relevant publications were searched up to October 2011. Randomised controlled trials comparing the effect of any prophylactic antibiotics with placebo for at least 3 months were included. The co-primary outcomes were the frequency of exacerbations of COPD or chronic bronchitis and adverse treatment events. RESULTS: A total of 19 trials involving 3932 subjects were included in the analysis: 5 recent trials included patients with moderate to severe COPD, whereas 14 older trials included patients with chronic bronchitis. The use of antibiotics significantly reduced the rate of COPD exacerbations (risk ratio [RR] 0.73, 95%CI 0.66-0.82), the number of chronic bronchitis exacerbations (standardised mean difference -0.23, 95%CI -0.35--0.11) and the proportion of patients with exacerbations of chronic bronchitis (RR 0.93, 95%CI 0.87-0.99). CONCLUSION: Prophylactic antibiotic treatment has a significant effect in reducing exacerbations in patients with COPD and/or chronic bronchitis.


Assuntos
Antibacterianos/uso terapêutico , Antibioticoprofilaxia/métodos , Bronquite Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Humanos , Prevenção Secundária
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