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Roshini Claire Anthony, 03 Sep 2018

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Prompt therapy a must to reduce mortality in severe bacterial infection patients

06 Jun 2020

Timing of appropriate therapy is important in the management of patients with severe bacterial infections, that is any delay should be avoided to reduce mortality in this population, according to a study.

Researchers performed a systematic review of available literature and searched multiple online databases for studies examining the impact of delayed appropriate therapy on clinical outcomes for hospitalized adult patients with bacterial infections. They pooled and analysed data by modelling delayed therapy three ways: delay vs no delay in receiving appropriate therapy; duration of delay; and inappropriate vs appropriate initial therapy.

Thirty-seven studies were included in the analysis: three prospective, 32 retrospective, and two case-control studies. Two studies were performed internationally, and 35 in single countries across Europe, Asia, and the US. Sample sizes ranged between 31 and 40,137 patients, with 26 studies analysing data from 100 patients.

Patient age range was 15–102 years, and average age ranged from 47 to 71 years. Most studies (85 percent) involved infections due to various organisms, and 14 examined infections caused by a single pathogen such as Staphylococcus aureus (five studies) and Streptococcus pneumoniae (three studies). Six studies assessed only infections caused by pathogens resistant to at least one class of antibiotic, or infections with those producing extended-spectrum beta-lactamases or carbapenemases.

Compared with delayed treatment, receipt of prompt appropriate therapy was associated with significantly lower mortality (odds ratio [OR], 0.57, 95 percent confidence interval [CI], 0.45–0.72). This was true in studies reporting mortality at 20–30 days (OR, 0.57, 95 percent CI, 0.43–0.76), mortality during intensive care unit stay (OR, 0.47, 95 percent CI, 0.27–0.80), and involving patients with bacteraemia (OR, 0.54, 95 percent CI, 0.40–0.75).

There was no difference seen in time to appropriate therapy between patients who died and those who survived (p=0.09), although heterogeneity between studies was high.

The present data highlight the importance of administering appropriate therapy early in the course of infection to improve meaningful outcomes such as mortality, the researchers said. It supports the recommended approach of early broad-spectrum empiric therapy, followed by de-escalation to targeted treatment, rather than use of antibiotic escalation strategies.

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Most Read Articles
Roshini Claire Anthony, 03 Sep 2018

The rate of syphilis reactivity appears to be higher in individuals with dementia compared with those without the condition, a Singapore study has found.

12 Jun 2019
Urogenital infections remain a major reason for women to visit their family physician and their subsequent referral to obstetrics and gynaecology or urology specialists. The association between abnormal vaginal microbiota and an increased risk of contracting sexually transmitted diseases (STDs), as well as an increased rate of preterm labour, indicates the need to better understand and manage urogenital health in women. Probiotics are “live microorganisms which, when administered in adequate amounts, confer a health benefit on the host”. As such, there is a sound rationale for using probiotics to maintain female vaginal and bladder health.
Jairia Dela Cruz, 16 Apr 2020
The odds of women passing coronavirus disease 2019 (COVID-19) to their sexual partners appear to be low, with two studies showing no evidence of the disease-causing SARS-CoV-2 virus existing in the vaginal fluids of infected patients.
Pank Jit Sin, 29 May 2020
With the world literally being put on hold by the SARS-CoV-2 virus, stakeholders around the world are rushing to develop a vaccine that will put back some semblance of normalcy into everyone’s lives.