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1. Macrolide therapy is associated with lower mortality in community-acquired bacteraemic pneumonia

Author

Arnold, F, Lopardo, G, Wiemken, T, Kelley, R, Peyrani, P, Mattingly, W, Feldman, C, Gnoni, M, Maurici, R, Ramirez, J, Ayesu, K, File, T, Burdette, S, Blatt, S, Restrepo, M, Bordon, J, Gross, P, Musher, D, Marrie, T, Weiss, K, Roig, J, Lode, H, Welte, T, Aliberti, S, Blasi, F, Cosentini, R, Legnani, D, Franzetti, F, Montano, N, Cervi, G, Rossi, P, Voza, A, Ostrowsky, B, Pesci, A, Nava, S, Viale, P, Galavatti, V, Patricia, A, Dimas, C, Piro, R, Viscoli, C, Torres, A, Valenti, V, Ojales, D, Bodi, M, Porras, J, Rello, J, Menendez, R, Stolz, D, Schuetz, P, Haubitz, S, Chalmers, J, Fardon, T, Benchetrit, G, Rodriguez, E, Corral, J, Gonzalez, J, de Vedia, L, Luna, C, Martinez, J, Marzoratti, L, Rodriguez, M, Videla, A, Saavedra, F, Lopez, H, Victorio, C, Riera, F, Jimenez, P, Fernandez, P, Parada, M, Fuenzalida, A, Riquelme, R, Barros, M, Luna, J, Toala, I, Oze de Morvil, G, Fernandez, R, Aiello, G, Alvarez, P, Soca, A, Arteta, F, Delgado, J, Levy, G, Rivero, L, Rodriguez, B, Mirabal, M, Mateo, M, Mendoza, M, Arnold, Forest W., Lopardo, Gustavo, Wiemken, Timothy L., Kelley, Robert, Peyrani, Paula, Mattingly, William A., Feldman, Charles, Gnoni, Martin, Maurici, Rosemeri, Ramirez, Julio A., Arnold, Forest, Ramirez, Julio, Ayesu, Kwabena, File, Thomas, Burdette, Steven, Blatt, Stephen, Restrepo, Marcos, Bordon, Jose, Gross, Peter, Musher, Daniel, Marrie, Thomas, Weiss, Karl, Roig, Jorge, Lode, Harmut, Welte, Tobias, Aliberti, Stephano, Blasi, Francesco, Cosentini, Roberto, Legnani, Delfino, Franzetti, Fabio, Montano, Nicola, Cervi, Giulia, Rossi, Paolo, Voza, Antonio, Ostrowsky, Belinda, Pesci, Alberto, Nava, Stefano, Viale, Pierluigi, Galavatti, Vanni, Patricia, Aruj, Dimas, Carlos, Piro, Roberto, Viscoli, Claudio, Torres, Antoni, Valenti, Vincenzo, Ojales, Daniel Portela, Bodi, Maria, Porras, Jose, Rello, Jordi, Menendez, Rosario, Stolz, Daiana, Schuetz, Philipp, Haubitz, Sebastian, Chalmers, James, Fardon, Tom, Benchetrit, Guillermo, Rodriguez, Eduardo, Corral, Jorge, Gonzalez, Jose, de Vedia, Lautaro, Luna, Carlos, Martinez, Jorge, Marzoratti, Lucia, Rodriguez, Maria, Videla, Alejandro, Saavedra, Federico, Lopez, Horacio, Victorio, Carlos, Riera, Fernando, Jimenez, Patricio, Fernandez, Patricia, Parada, Maria, Fuenzalida, Alejandro Díaz, Riquelme, Raul, Barros, Manuel, Luna, Juan Manuel, Toala, Ivan, Oze de Morvil, Guillermo Arbo, Fernandez, Ricardo, Aiello, Gonzalo, Alvarez, Pablo, Soca, Ana, Arteta, Federico, Delgado, Jose, Levy, Gur, Rivero, Ludwig, Rodriguez, Benito, Mirabal, Mario Perez, Mateo, Marilyn, Mendoza, Myrna, Arnold, F, Lopardo, G, Wiemken, T, Kelley, R, Peyrani, P, Mattingly, W, Feldman, C, Gnoni, M, Maurici, R, Ramirez, J, Ayesu, K, File, T, Burdette, S, Blatt, S, Restrepo, M, Bordon, J, Gross, P, Musher, D, Marrie, T, Weiss, K, Roig, J, Lode, H, Welte, T, Aliberti, S, Blasi, F, Cosentini, R, Legnani, D, Franzetti, F, Montano, N, Cervi, G, Rossi, P, Voza, A, Ostrowsky, B, Pesci, A, Nava, S, Viale, P, Galavatti, V, Patricia, A, Dimas, C, Piro, R, Viscoli, C, Torres, A, Valenti, V, Ojales, D, Bodi, M, Porras, J, Rello, J, Menendez, R, Stolz, D, Schuetz, P, Haubitz, S, Chalmers, J, Fardon, T, Benchetrit, G, Rodriguez, E, Corral, J, Gonzalez, J, de Vedia, L, Luna, C, Martinez, J, Marzoratti, L, Rodriguez, M, Videla, A, Saavedra, F, Lopez, H, Victorio, C, Riera, F, Jimenez, P, Fernandez, P, Parada, M, Fuenzalida, A, Riquelme, R, Barros, M, Luna, J, Toala, I, Oze de Morvil, G, Fernandez, R, Aiello, G, Alvarez, P, Soca, A, Arteta, F, Delgado, J, Levy, G, Rivero, L, Rodriguez, B, Mirabal, M, Mateo, M, Mendoza, M, Arnold, Forest W., Lopardo, Gustavo, Wiemken, Timothy L., Kelley, Robert, Peyrani, Paula, Mattingly, William A., Feldman, Charles, Gnoni, Martin, Maurici, Rosemeri, Ramirez, Julio A., Arnold, Forest, Ramirez, Julio, Ayesu, Kwabena, File, Thomas, Burdette, Steven, Blatt, Stephen, Restrepo, Marcos, Bordon, Jose, Gross, Peter, Musher, Daniel, Marrie, Thomas, Weiss, Karl, Roig, Jorge, Lode, Harmut, Welte, Tobias, Aliberti, Stephano, Blasi, Francesco, Cosentini, Roberto, Legnani, Delfino, Franzetti, Fabio, Montano, Nicola, Cervi, Giulia, Rossi, Paolo, Voza, Antonio, Ostrowsky, Belinda, Pesci, Alberto, Nava, Stefano, Viale, Pierluigi, Galavatti, Vanni, Patricia, Aruj, Dimas, Carlos, Piro, Roberto, Viscoli, Claudio, Torres, Antoni, Valenti, Vincenzo, Ojales, Daniel Portela, Bodi, Maria, Porras, Jose, Rello, Jordi, Menendez, Rosario, Stolz, Daiana, Schuetz, Philipp, Haubitz, Sebastian, Chalmers, James, Fardon, Tom, Benchetrit, Guillermo, Rodriguez, Eduardo, Corral, Jorge, Gonzalez, Jose, de Vedia, Lautaro, Luna, Carlos, Martinez, Jorge, Marzoratti, Lucia, Rodriguez, Maria, Videla, Alejandro, Saavedra, Federico, Lopez, Horacio, Victorio, Carlos, Riera, Fernando, Jimenez, Patricio, Fernandez, Patricia, Parada, Maria, Fuenzalida, Alejandro Díaz, Riquelme, Raul, Barros, Manuel, Luna, Juan Manuel, Toala, Ivan, Oze de Morvil, Guillermo Arbo, Fernandez, Ricardo, Aiello, Gonzalo, Alvarez, Pablo, Soca, Ana, Arteta, Federico, Delgado, Jose, Levy, Gur, Rivero, Ludwig, Rodriguez, Benito, Mirabal, Mario Perez, Mateo, Marilyn, and Mendoza, Myrna

Abstract

Background: Community-acquired pneumonia (CAP) has a potential complication of bacteremia. The objective of this study was to define the clinical outcomes of patients with CAP and bacteremia treated with and without a macrolide. Materials and methods: Secondary analysis of the Community-Acquired Pneumonia Organization database of hospitalized patients with CAP. Patients with a positive blood culture were categorized based on the presence or absence of a macrolide in their initial antimicrobial regimen, and severity of their CAP. Outcomes included in-hospital all-cause mortality, 30-day mortality, length of stay, and time to clinical stability. Results: Among 549 patients with CAP and bacteremia, 247 (45%) were treated with a macrolide and 302 (55%) were not. The primary pathogen was Streptococcus pneumoniae (74%). Poisson regression with robust error variance models were used to compare the adjusted effects of each study group on the outcomes. The unadjusted 30-day mortality was 18.4% in the macrolide group, and 29.6% in the non-macrolide group (adjusted relative risk (aRR)0.81; 95% confidence interval (CI)0.50–1.33; P = 0.41). Unadjusted in-hospital all-cause mortality was 7.3% in the macrolide group, and 18.9% in the non-macrolide group (aRR 0.54, 95% CI 0.30–0.98; P = 0.043). Length of stay and time to clinical stability were not significantly different. Conclusions: In-hospital mortality, but not 30-day mortality, was significantly better in the macrolide group. Our data support the use of a macrolide in hospitalized patients with CAP and bacteraemia

Published
2018

2. Macrolide therapy is associated with lower mortality in community-acquired bacteraemic pneumonia

Author

Forest W. Arnold, Gustavo Lopardo, Timothy L. Wiemken, Robert Kelley, Paula Peyrani, William A. Mattingly, Charles Feldman, Martin Gnoni, Rosemeri Maurici, Julio A. Ramirez, Forest Arnold, Julio Ramirez, Kwabena Ayesu, Thomas File, Steven Burdette, Stephen Blatt, Marcos Restrepo, Jose Bordon, Peter Gross, Daniel Musher, Thomas Marrie, Karl Weiss, Jorge Roig, Harmut Lode, Tobias Welte, Stephano Aliberti, Francesco Blasi, Roberto Cosentini, Delfino Legnani, Fabio Franzetti, Nicola Montano, Giulia Cervi, Paolo Rossi, Antonio Voza, Belinda Ostrowsky, Alberto Pesci, Stefano Nava, Pierluigi Viale, Vanni Galavatti, Aruj Patricia, Carlos Dimas, Roberto Piro, Claudio Viscoli, Antoni Torres, Vincenzo Valenti, Daniel Portela Ojales, Maria Bodi, Jose Porras, Jordi Rello, Rosario Menendez, Daiana Stolz, Philipp Schuetz, Sebastian Haubitz, James Chalmers, Tom Fardon, Guillermo Benchetrit, Eduardo Rodriguez, Jorge Corral, Jose Gonzalez, Lautaro de Vedia, Carlos Luna, Jorge Martinez, Lucia Marzoratti, Maria Rodriguez, Alejandro Videla, Federico Saavedra, Horacio Lopez, Carlos Victorio, Fernando Riera, Patricio Jimenez, Patricia Fernandez, Maria Parada, Alejandro Díaz Fuenzalida, Raul Riquelme, Manuel Barros, Juan Manuel Luna, Ivan Toala, Guillermo Arbo Oze de Morvil, Ricardo Fernandez, Gonzalo Aiello, Pablo Alvarez, Ana Soca, Federico Arteta, Jose Delgado, Gur Levy, Ludwig Rivero, Benito Rodriguez, Mario Perez Mirabal, Marilyn Mateo, Myrna Mendoza, Arnold, F, Lopardo, G, Wiemken, T, Kelley, R, Peyrani, P, Mattingly, W, Feldman, C, Gnoni, M, Maurici, R, Ramirez, J, Ayesu, K, File, T, Burdette, S, Blatt, S, Restrepo, M, Bordon, J, Gross, P, Musher, D, Marrie, T, Weiss, K, Roig, J, Lode, H, Welte, T, Aliberti, S, Blasi, F, Cosentini, R, Legnani, D, Franzetti, F, Montano, N, Cervi, G, Rossi, P, Voza, A, Ostrowsky, B, Pesci, A, Nava, S, Viale, P, Galavatti, V, Patricia, A, Dimas, C, Piro, R, Viscoli, C, Torres, A, Valenti, V, Ojales, D, Bodi, M, Porras, J, Rello, J, Menendez, R, Stolz, D, Schuetz, P, Haubitz, S, Chalmers, J, Fardon, T, Benchetrit, G, Rodriguez, E, Corral, J, Gonzalez, J, de Vedia, L, Luna, C, Martinez, J, Marzoratti, L, Rodriguez, M, Videla, A, Saavedra, F, Lopez, H, Victorio, C, Riera, F, Jimenez, P, Fernandez, P, Parada, M, Fuenzalida, A, Riquelme, R, Barros, M, Luna, J, Toala, I, Oze de Morvil, G, Fernandez, R, Aiello, G, Alvarez, P, Soca, A, Arteta, F, Delgado, J, Levy, G, Rivero, L, Rodriguez, B, Mirabal, M, Mateo, M, and Mendoza, M

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Databases, Factual, Community-acquired pneumonia, Antimicrobial treatment, Bacteremia, Kaplan-Meier Estimate, medicine.disease_cause, Severity of Illness Index, 03 medical and health sciences, symbols.namesake, 0302 clinical medicine, Internal medicine, Streptococcus pneumoniae, medicine, Pneumonia, Bacterial, Humans, 030212 general & internal medicine, Poisson regression, Hospital Mortality, Mortality, Aged, Aged, 80 and over, business.industry, Length of Stay, Middle Aged, medicine.disease, Confidence interval, Anti-Bacterial Agents, Community-Acquired Infections, Pneumonia, Regimen, Treatment Outcome, 030228 respiratory system, Relative risk, symbols, Drug Therapy, Combination, Female, Macrolides, business
Abstract

Background Community-acquired pneumonia (CAP) has a potential complication of bacteremia. The objective of this study was to define the clinical outcomes of patients with CAP and bacteremia treated with and without a macrolide. Materials and methods Secondary analysis of the Community-Acquired Pneumonia Organization database of hospitalized patients with CAP. Patients with a positive blood culture were categorized based on the presence or absence of a macrolide in their initial antimicrobial regimen, and severity of their CAP. Outcomes included in-hospital all-cause mortality, 30-day mortality, length of stay, and time to clinical stability. Results Among 549 patients with CAP and bacteremia, 247 (45%) were treated with a macrolide and 302 (55%) were not. The primary pathogen was Streptococcus pneumoniae (74%). Poisson regression with robust error variance models were used to compare the adjusted effects of each study group on the outcomes. The unadjusted 30-day mortality was 18.4% in the macrolide group, and 29.6% in the non-macrolide group (adjusted relative risk (aRR)0.81; 95% confidence interval (CI)0.50–1.33; P = 0.41). Unadjusted in-hospital all-cause mortality was 7.3% in the macrolide group, and 18.9% in the non-macrolide group (aRR 0.54, 95% CI 0.30–0.98; P = 0.043). Length of stay and time to clinical stability were not significantly different. Conclusions In-hospital mortality, but not 30-day mortality, was significantly better in the macrolide group. Our data support the use of a macrolide in hospitalized patients with CAP and bacteraemia.

Published
2018

3. Epidemiological trends and outcomes of children with aural foreign bodies in Singapore.

Author

Duan M, Morvil G, Badron J, and Ganapathy S

Subjects
Adolescent, Child, Child, Preschool, Emergency Service, Hospital, Female, Humans, Infant, Infant, Newborn, Male, Retrospective Studies, Singapore epidemiology, Foreign Bodies diagnosis, Foreign Bodies epidemiology, Foreign Bodies therapy
Abstract

Introduction: Aural foreign bodies (FBs) are a common presenting complaint in emergency departments (EDs) worldwide. This study aims to describe trends and outcomes of aural FBs in the paediatric population, presenting to a tertiary hospital in Singapore., Methods: A retrospective review of medical records was conducted of all children 0-16 years old with aural FBs who presented to KK Women's and Children's Hospital ED from 2013 to 2017. Clinical data that were collected include patient demographics, type of FB, ear compartment and laterality of FB, symptoms, duration of impaction, mode of removal, outcome in ED, and final disposition., Results: There were a total of 1,003 cases. The largest age group consisted of 53.7% preschool children of 0-6 years. Males (61.7%) were more common than females (38.3%). FBs were predominantly organic materials (25.6%), followed by beads and stones (15.2%). Most FBs were found in the right ear (56.6%). The majority of patients were asymptomatic (62%). Symptoms observed included ear pain (20.1%), itch (4.8%) and bleeding (3.2%). FBs were removed by instruments (36.6%), suctioning (15.4%), syringing (8.2%), or a combination of methods (13.7%). In the ED, 73.9% of patients had an attempt at removal, among which 78.4% of FBs were successfully removed, 5.9% required specialist review, and 15.7% were unsuccessful., Conclusion: The majority of paediatric aural FBs can be successfully removed in the ED. Emergency physicians should be trained and equipped with the relevant skills to remove aural FBs.

Published
2022
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5. Assessment of aPTT-based clot waveform analysis for the detection of haemostatic changes in different types of infections.

Author

Tan CW, Wong WH, Cheen MHH, Chu YMH, Lim SS, Ng LCK, Yeo DGD, Morvil G, Lee LH, and Ng HJ

Subjects
Aged, Aged, 80 and over, C-Reactive Protein analysis, Dengue blood, Disseminated Intravascular Coagulation blood, Disseminated Intravascular Coagulation etiology, Elective Surgical Procedures, Female, Humans, Male, Middle Aged, Procalcitonin blood, Respiratory Tract Infections blood, Bacterial Infections blood, Hemostasis, Partial Thromboplastin Time methods, Virus Diseases blood
Abstract

Infections cause varying degrees of haemostatic dysfunction which can be detected by clot waveform analysis (CWA), a global haemostatic marker. CWA has been shown to predict poor outcomes in severe infections with disseminated intravascular coagulopathy. The effect of less severe bacterial and viral infections on CWA has not been established. We hypothesized that different infections influence CWA distinctively. Patients admitted with bacterial infections, dengue and upper respiratory tract viral infections were recruited if they had an activated partial thromboplastin time (aPTT) measured on admission. APTT-based CWA was performed on Sysmex CS2100i automated analyser using Dade Actin FSL reagent. CWA parameters [(maximum velocity (min1), maximum acceleration (min2) and maximum deceleration (max2)] were compared against control patients. Infected patients (n = 101) had longer aPTT than controls (n = 112) (34.37 ± 7.72 s vs 27.80 ± 1.59 s, p < 0.001), with the mean (± SD) aPTT longest in dengue infection (n = 36) (37.99 ± 7.93 s), followed by bacterial infection (n = 52) (33.96 ± 7.33 s) and respiratory viral infection (n = 13) (29.98 ± 3.92 s). Compared to controls (min1; min2; max2) (5.53 ± 1.16%/s; 0.89 ± 0.19%/s 2 ; 0.74 ± 0.16%/s 2 ), bacterial infection has higher CWA results (6.92 ± 1.60%/s; 1.04 ± 0.28%/s 2 ; 0.82 ± 0.24%/s 2 , all p < 0.05); dengue infection has significantly lower CWA values (3.93 ± 1.32%/s; 0.57 ± 0.17%/s 2 ; 0.43 ± 0.14%/s 2 , all p < 0.001) whilst respiratory virus infection has similar results (6.19 ± 1.32%/s; 0.95 ± 0.21%/s 2 ; 0.73 ± 0.18%/s 2 , all p > 0.05). CWA parameters demonstrated positive correlation with C-reactive protein levels (min1: r = 0.54, min2: r = 0.44, max2: r = 0.34; all p < 0.01). Different infections affect CWA distinctively. CWA could provide information on the haemostatic milieu triggered by infection and further studies are needed to better define its application in this area.

Published
2020
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