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22 results

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  • Incidence and risk factors for clinically confirmed secondary bacterial infections in patients hospitalized for coronavirus disease 2019 (COVID-19)
  • Hiromichi S. Park, Caitlin M. McCracken, Noah Lininger, Cara D. Varley, Monica K. Sikka, Christopher Evans, Angela Holly Villamagna, Jina T. Makadia, Jessina C. McGregor
  • Journal: Infection Control & Hospital Epidemiology , First View
  • Published online by Cambridge University Press: 15 May 2023, pp. 1-7
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  • View abstract
    Objective:

    The true incidence and risk factors for secondary bacterial infections in coronavirus disease 2019 (COVID-19) remains poorly understood. Knowledge of risk factors for secondary infections in hospitalized patients with COVID-19 is necessary to optimally guide selective use of empiric antimicrobial therapy.

    Design:

    Single-center retrospective cohort study of symptomatic inpatients admitted for COVID-19 from April 15, 2020, through June 30, 2021.

    Setting:

    Academic quaternary-care referral center in Portland, Oregon.

    Patients:

    The study included patients who were 18 years or older with a positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) PCR test up to 10 days prior to admission.

    Methods:

    Secondary infections were identified based on clinical, radiographic, and microbiologic data. Logistic regression was used to identify risk factors for secondary infection. We also assessed mortality, length of stay, and empiric antibiotics among those with and without secondary infections.

    Results:

    We identified 118 patients for inclusion; 31 (26.3%) had either culture-proven or possible secondary infections among hospitalized patients with COVID-19. Mortality was higher among patients with secondary infections (35.5%) compared to those without secondary infection (4.6%). Empiric antibiotic use on admission was high in both the secondary and no secondary infection groups at 71.0% and 48.3%, respectively.

    Conclusions:

    The incidence of secondary bacterial infection was moderate among hospitalized patients with COVID-19. However, a higher proportion of patients received empiric antibiotics regardless of an identifiable secondary infection. Transfer from an outside hospital, baseline immunosuppressant use, and corticosteroid treatment were independent risk factors for secondary infection. Additional studies are needed to validate risk factors and best guide antimicrobial stewardship efforts.

Transparency in Health and Health Care in the United States
  • Transparency in Health and Health Care in the United States
  • Law and Ethics
  • Edited by Holly Fernandez Lynch, I. Glenn Cohen, Carmel Shachar, Barbara J. Evans
  • Published online: 19 June 2019
  • Print publication: 06 June 2019
  • View description
    Transparency is a concept that is becoming increasingly lauded as a solution to a host of problems in the American health care system. Transparency initiatives show great promise, including empowering patients and other stakeholders to make more efficient decisions, improve resource allocation, and better regulate the health care industry. Nevertheless, transparency is not a cure-all for the problems facing the modern health care system. The authors of this volume present a nuanced view of transparency, exploring ways in which transparency has succeeded and ways in which transparency initiatives have room for improvement. Working at the intersection of law, medicine, ethics, and business, the book goes beyond the buzzwords to the heart of transparency's transformative potential, while interrogating its obstacles and downsides. It should be read by anyone looking for a better understanding of transparency in the health care context.
  • Management of malignant (necrotising) otitis externa
  • S Hollis, K Evans
  • Journal: The Journal of Laryngology & Otology / Volume 125 / Issue 12 / December 2011
  • Published online by Cambridge University Press: 03 October 2011, pp. 1212-1217
  • Print publication: December 2011
  • View abstract

    Although malignant (necrotising) otitis externa is not a common diagnosis, there have been a number of recently reported cases with pathogens other than Pseudomonas aeruginosa as the causative organism. In addition, there are many published reports of resistance to antibiotics in cases of malignant otitis externa caused by Pseudomonas aeruginosa. This review aims to assess the cases reported and to clarify the current opinion on the diagnostic criteria and management of such cases.

  • Monitoring important coastal sites for bottlenose dolphin in Cardigan Bay, UK
  • Chris Pierpoint, Liz Allan, Holly Arnold, Peter Evans, Sarah Perry, Lizzie Wilberforce, Janet Baxter
  • Journal: Journal of the Marine Biological Association of the United Kingdom / Volume 89 / Issue 5 / August 2009
  • Published online by Cambridge University Press: 21 July 2009, pp. 1033-1043
  • View abstract

    From 1994–2007 Ceredigion County Council and a network of shore-based, volunteer observers monitored levels of boat traffic and the occurrence of bottlenose dolphins Tursiops truncatus at seven sites on the coast of Cardigan Bay, Wales. We report high rates of site use and site occupancy by this species during the summer: at Mwnt for example, dolphins were recorded in >80% of 2 hours' observation periods; and at New Quay Harbour dolphins were present in >30% of all 15-minute intervals. At Mwnt and Aberporth there was a significant annual trend for increasing sighting rates; at Ynys Lochtyn a positive trend was only marginally non-significant; at New Quay Bird's Rock the trend was ambiguous but appeared stable over the seven most recent years. Although trends in site use may not reflect population trends in the wider region, these data were consistent with recent abundance estimates that indicate that the number of bottlenose dolphins using Cardigan Bay is stable or slightly increasing. Average group size at our study sites was small (<3 animals), which contrasts with observations of larger schools of the same population elsewhere in their range. The predominant behaviour in coastal Cardigan Bay is demersal foraging, often by solitary animals in shallow near-shore habitats. There was evidence that boat traffic suppressed site use by dolphins at New Quay Harbour, the busiest monitoring site: sighting rates fell when high numbers of boats were present and sighting rates were higher in 2007 than in previous years, when boat use was reduced due to poor weather during the main tourist season. This study demonstrates that networks of volunteer observers can provide a cost-effective, non-invasive means of gathering data on marine mammals for the purposes of coastal zone management.

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