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Isolation of multidrug-resistant gram-negative bacteria (MDR-GNB) from patients in the community has been increasingly observed. A prediction model for MDR-GNB colonization and infection risk stratification on hospital admission is needed to improve patient care.
A 2-stage, prospective study was performed with 995 and 998 emergency department patients enrolled, respectively. MDR-GNB colonization was defined as isolates resistant to 3 or more classes of antibiotics, identified in either the surveillance or early (≤48 hours) clinical cultures.
A score-assigned MDR-GNB colonization prediction model was developed and validated using clinical and microbiological data from 995 patients enrolled in the first stage of the study; 122 of these patients (12.3%) were MDR-GNB colonized. We identified 5 independent predictors: age>70 years (odds ratio [OR], 1.84 [95% confidence interval (CI), 1.06–3.17]; 1 point), assigned point value in the model), residence in a long-term-care facility (OR, 3.64 [95% CI, 1.57–8.43); 3 points), history of cerebrovascular accidents (OR, 2.23 [95% CI, 1.24–4.01]; 2 points), hospitalization within 1 month (OR, 2.63 [95% CI, 1.39–4.96]; 2 points), and recent antibiotic exposure (OR, 2.18 [95% CI, 1.16–4.11]; 2 points). The model displayed good discrimination in the derivation and validation sets (area under ROC curve, 0.75 and 0.80, respectively) with the best cutoffs of<4 and ≥4 points for low- and high-risk MDR-GNB colonization, respectively. When applied to 998 patients in the second stage of the study, the model successfully stratified the risk of MDR-GNB infection during hospitalization between low- and high-risk groups (probability, 0.02 vs 0.12, respectively; log-rank test, P<.001).
A model was developed to optimize both the decision to initiate antimicrobial therapy and the infection control interventions to mitigate threats from MDR-GNB.
The potential relationship between anaesthesia, surgery and onset of
dementia remains elusive.
To determine whether the risk of dementia increases after surgery with
anaesthesia, and to evaluate possible associations among age, mode of
anaesthesia, type of surgery and risk of dementia.
The study cohort comprised patients aged 50 years and older who were
anaesthetised for the first time since 1995 between 1 January 2004 and 31
December 2007, and a control group of randomly selected patients matched
for age and gender. Patients were followed until 31 December 2010 to
identify the emergence of dementia.
Relative to the control group, patients who underwent anaesthesia and
surgery exhibited an increased risk of dementia (hazard ratio = 1.99) and
a reduced mean interval to dementia diagnosis. The risk of dementia
increased in patients who received intravenous or intramuscular
anaesthesia, regional anaesthesia and general anaesthesia.
The results of our nationwide, population-based study suggest that
patients who undergo anaesthesia and surgery may be at increased risk of
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