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Analysis of prognosis factors for Pseudomonas aeruginosa bacteremia and risk factors for multidrug-resistant Pseudomonas aeruginosa bacteremia with emphasis on the effect of ntimicrobial therapy
No full text研究目的： 評估合併或單一抗生素治療以及經驗性治療適當與否對於綠膿桿菌菌血症患者之臨床治療效果，並辨別導致病人死亡之危險因子；另外也針對多重抗藥性綠膿桿菌菌血症患者進行危險因子分析。究設計、地點及對象： 此研究於國立臺灣大學醫學院附設醫院-臺灣一家醫學中心進行，為單中心、回溯性世代分析研究。研究對象為西元2007年1月1日至2007年11月31日期間感染綠膿桿菌菌血症之成年病患。 究方法： 自行設計之個案報告表為本研究收集資料之基本工具，記錄紙本病歷以及電子病歷所記載之相關變項，包含病人基本資料、合併症、造成感染之潛在因子等，並於綠膿桿菌菌血症發作前三十天內，記錄是否有細菌感染之情形以及所使用的抗生素；在綠膿桿菌菌血症發作時，記錄可能感染源及臨床表徵、相關檢驗數據、細菌檢驗結果及感染嚴重程度之評估；於綠膿桿菌菌血症發作後，記錄使用之抗生素、後續細菌培養結果以及相關之預後因子，並以菌血症發作後之三十天（D30）死亡率為觀察終點。另外也針對感染多重抗藥性綠膿桿菌菌血症之病人進行危險因子之分析。統計方法包含單變項分析以及多變項羅吉斯迴歸分析，存活曲線以Kaplan-Meier method繪製，並以Log-rank test進行比較。究結果： 本研究共收集了186個事件，有120事件（65％）為單一菌種感染；病人之平均年齡為61.2±18.4歲，男性佔56％；病人之平均Charlson’s comorbidity index為4.09±2.37分，過去一個月內有使用過抗生素及抗綠膿桿菌抗生素之比例分別為76.2％及43.8％。菌血症發作當下病人之平均Pitt bacteremia score為3.8±3.5分，39.8％之患者有敗血性休克；經驗性治療使用合併治療者僅有14事件（7.7％），確切治療使用合併治療者有38事件（24.4％）；由菌血症發作至使用適當抗生素之平均時間為34±46小時。有27事件（14.2％）為多重抗藥性綠膿桿菌菌血症感染。全體及單一菌種病人之D30總死亡率分別為41.4％及46.7％。 以單一菌種感染來說，經驗性合併或單一治療對於經驗性治療適當與否並無顯著之關係（77.8％ vs. 61.5％，P=0.48），而經驗性合併或單一治療對於死亡率也無顯著影響（44.4％ vs. 46.8％，P=1.00）；另外，合併或單一治療對於是否會減少重疊感染、抗藥性菌種之產生於統計上並未有顯著之差異。 由多變項羅吉斯迴歸分析發現，感染MDRPA之危險因子有過去六個月內曾有MDRPA感染或移生（OR 28.27，P<0.0001）、過去三十天內有使用過carbapenem（OR 12.2，P=0.0001）、過去三十天內使用過fluoroquinolone（FQ）（OR 9.30，P=0.005）、腦血管疾病（OR 5.45，P=0.02）以及此次菌血症感染前之住院天數（OR 1.01，P=0.02）。 由多變項羅吉斯迴歸分析發現影響全部病人第七天（D7）死亡率的獨立危險因子有肝膽疾病（OR 5.15，P=0.0124）、Pitt bacteremia score （OR 1.93，P<0.0001）以及年齡（OR 1.04，P=0.02）；影響單一菌種感染病人之D7死亡率的危險因子有：急性腎衰竭（OR 6.12，P=0.02）以及Pitt bacteremia score（OR 1.97，P<0.0001）。而影響全部病人D30死亡率之獨立危險因子有敗血性休克（OR 4.15，P=0.008）、肝膽疾病（OR 3.82，P=0.02）、之前使用過抗綠膿桿菌抗生素（OR 3.11，P=0.02）、免疫抑制劑之使用（OR 2.98，P=0.02）、Pitt bacteremia score （OR 1.52，P<0.0001）以及Charlson’s comorbidity index（OR 1.22，P=0.04），而多重菌種感染為保護因子（OR 0.31，P=0.02）；影響單一菌種感染病人D30死亡率的危險因子有：院內感染（OR 7.64，P=0.01）、敗血性休克（OR 4.97，P=0.011）、免疫抑制劑之使用（OR 4.37，P=0.006）以及Pitt bacteremia score（OR 1.46，P=0.007）。經驗性合併治療與否以及經驗性治療適當與否於分析中並未顯著影響預後。論： 經驗性治療並不會影響到綠膿桿菌菌血症患者之預後；D30死亡率僅與病人本身之情況（Charlson’s comorbidity index、肝膽疾病、是否有使用免疫抑制劑）以及菌血症發作時之嚴重程度（Pitt bacteremia score、敗血性休克）有關；另外，過去有使用過FQ或是carbapenem者、住院較久、腦血管疾病者、先前已有多重抗藥性綠膿桿菌感染或移生者為易感染多重抗藥性綠膿桿菌菌株之危險族群。Objectives:his study is aim to evaluate the impact of antibiotic combination therapy and adequate empirical treatment on clinical outcomes and to identify the prognosis factors for Pseudomonas aeruginosa bacteremia. The other goal of this study is to investigate the risk factors for multidrug-resistant Pseudomonas aeruginosa (MDRPA) bacteremia.tudy location、design and study populations: retrospective cohort analysis was performed for all adult patients admitted to the National Taiwan University Hospital (NTUH) with positive P. aeruginosa blood culture between 1 January 2007 and 31 November 2007 .ethods:ata were collected from medical records and hospital computerized databases. The data retrieved for each patient included patients’ profile, underlying diseases, previous hospitalization history, previous P. aeruginosa infection or colonization history, antibiotics exposure before bacteremia onset, clinical presentation, antibiotics regimens at bacteremia onset, management and clinical response after bacteremia. The primary endpoint was 30 day all-caused mortality. Risk factors of MDRPA bacteremia were also analysed. Risk factors and clinical outcomes were examed using univariate analysis and multivariate logistic regression analysis. Survival curves shown by Kaplan-Meier method were compared with Log-rank test. esult:ne hundred and eighty six episodes were included in this study, 120 (65%) were monomicrobial infections and 66 polymicrobial infections. Patients’ average age was 61.2±18.4 and 56% of them were male. The average Charlson comorbidity index of included patients was 4.09±2.37. Previous exposure to antibiotics and anti- Pseudomonas antibiotics were 76.2% and 43.8% respectively. Patients’ average Pitt bacteremia scores were 3.8±3.5. All episodes were presented with sepsis with 39.8% of septic shock. After the onset of symptoms, it took an average of 34±46 hours to initiate an adequate therapy. Empirical combination therapy was given only in 14 episodes (7.7%) and definitive combination therapy was used in 38 episodes (24.4%).There were 27 (14.2%) MDRPA episodes. The overall D30 mortality was 41.4%, and 46.7% for monomicrobial infections.mpirical monotherapy and combination therapy provided comparably adequate therapy (77.8% vs. 61.5 %, P=0.48) with similar D30 mortality in combination therapy and monotherapy (44.4% vs. 46.8%, P=1.00). Also, the superinfection and emergence of resistance after the bacteremia onset did not differ significantly between two regimens.ultivariate logistic regression identified the following variables as significant independent risk factors for MDRPA bacteremia: P. aeruginosa infection or colonization within previous 6 months (OR 28.27, P<0.0001), fluoroquinolone usage (OR 9.30, P=0.005), carbapenem usage (OR 12.2, P=0.0001), cerebrovascular accidents (OR 5.45, P=0.02) and lengh of hospital stay before bacteremia (OR 1.01, P=0.02).ach of the following factors were independently associated with 30-day mortality in all patients: septic shock (OR 4.15, P=0.008), hepatobiliary diseases (OR 3.82, P=0.02), exposure to anti- Pseudomonas agents (OR 3.11, P=0.02), immunosuppressant (OR 2.98, P=0.02), Pitt bacteremia score (OR 1.52, P<0.0001) and Charlson’s comorbidity index (OR 1.22, P=0.04). Polymicrobial infection was a protective factor (OR 0.31, P=0.02). Empirical therapy was not significantly associated with mortality in all and monomicrobial patients. onclusion:his study showed empirical therapy did not affect mortality in P. aeruginosa bacteremia patients. Patients’ comorbidity and severity of illness at bacteremia onset played important roles on mortality. Exposure to carbapenem and fluoroquinolone were associated with MDRPA bacteremia acquisition.口試委員審定書 i謝 ii文摘要 iiibstract vi錄 ix目錄 xi目錄 xii英對照表 xiv一章 緒論 1二章 文獻探討 31節 細菌學 32節 流行病學 73節 綠膿桿菌菌血症之感染 104節 綠膿桿菌之體外藥物敏感性試驗 175節 綠膿桿菌之治療 186節 綠膿桿菌單一治療及合併治療 187節 抗生素治療適當與否及延遲與預後之關係 238節 綠膿桿菌菌血症之死亡危險因子 24三章 研究目的 26四章 研究方法 271節 研究架構 272節 研究地點及研究對象 283節 資料收集 284節 名詞定義 335節 統計分析方法 36五章 研究結果 371節 描述性統計 372節 感染多重抗藥性綠膿桿菌菌血症之單變項統計分析 613節 感染多重抗藥性綠膿桿菌菌血症之多變項統計分析 674節 存活曲線 675節 死亡危險因子之單變項統計分析 716節 死亡危險因子之多變項統計分析 82六章 討論 841節 感染綠膿桿菌菌血症之病人族群 842節 抗生素治療 843節 感染多重抗藥性綠膿桿菌菌血症之危險因子 914節 死亡率分析 935節 死亡之危險因子 946節 研究限制 97七章 結論 100八章 參考資料 10
Clopidogrel-Associated Neutropenia: Case Report and Review of the Literature
No full textClopidogrel is a second generation of thienopyridine, which has antiplatelet effect by inhibiting P2Y(12) receptor. Hematologic adverse effect is very uncommon during clopidogrel use, but some cases of clopidogrel-associated neutropenia were reported in the past decade. Until now, there was no summary data to delineate the clinical course and safe alternatives of this event. We report 2 cases of clopidogrel-associated neutropenia and review other 10 case reports from 2000 to 2014. The median onset of neutropenia was 22 days, and the recovery time was 4 days after receiving granulocyte-colony-stimulating factor. Bone marrow studies in 6 cases all showed hypocellular or toxic damage. Six cases used cilostazol, prasugrel, or ticagrelor as safe alternatives. Closely monitoring blood cell counts is highly suggested in the first month after using clopidogrel. Newer P2Y(12) inhibitors, especially ticagrelor, could be effective and safe alternatives if patients had a history of clopidogrel-associated neutropenia
Going Beyond Counting First Authors in Author Co-citation Analysis
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counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
Author-wise bibliometric analysis based on entropy.
No full textAuthor-wise bibliometric analysis based on entropy.</p
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