Biomedical subjects

Patricia D Brown

Publications and source records attributed to Patricia D Brown.

5 recordsLinked to original sources

PubMed2004

Antimicrobial Selection in the Treatment of Pyelonephritis.

Pyelonephritis is a common clinical entity, although accurate data regarding the true prevalence of this infection are lacking. Acute pyelonephritis is associated with significant morbidity and even mortality. There are very few randomized controlled clinical trials that have addressed the optimal management strategies and antimicrobial therapy for this infection. Increasing resistance among uropathogens, especially Escherichia coli, has impacted recommendations for empiric antimicrobial therapy, and fluoroquinolones have emerged as the empiric therapy of choice for individuals managed as outpatients; more options are available for empiric parenteral therapy for those who require hospitalization. Further study of the epidemiology of antimicrobial resistance among uropathogens and of alternative agents for the management of pyelonephritis is urgently needed.

Journal Article↗

PubMed2004

Adherence to guidelines for community-acquired pneumonia: does it decrease cost of care?

Community-acquired pneumonia (CAP) is a common diagnosis and care of CAP is responsible for significant healthcare expenditures, the majority of which are for patients who require hospitalisation. Studies have shown that significant variation exists among institutions with respect to antibacterial costs and length of stay (LOS) for CAP. These variations do not appear to be associated with significant differences in patient outcomes. This information has stimulated the development of practice guidelines and critical pathways to optimise the care of patients with CAP. The central focus of guidelines is recommendations for antibacterial therapy; critical pathways include recommendations for therapy, but focus on the process of care for patients with CAP. Guidelines and critical pathways are time consuming to develop and their implementation requires significant institutional resources. Therefore, it is essential that they are shown to be effective, and there has been significant interest in determining if guidelines and pathways can improve the cost effectiveness of care. In the past several years, a number of studies have evaluated the impact of treatment consistent with guidelines on outcomes for patients with CAP. These studies have shown that antibacterial therapy that is consistent with guidelines can reduce LOS, decrease costs, and several have shown a favourable impact on mortality. The majority of these studies have been retrospective reviews. One multicenter prospective, randomised trial of a critical pathway for CAP revealed significant reductions in the hospital admission of patients, LOS and cost of care. Other studies of processes of care have been mainly 'before and after' interventions; many have shown reductions in LOS and costs. Based on the available data, it is reasonable to expect that adherence to guidelines and critical pathways can reduce the cost of care for CAP; however, randomised controlled trials that include a formal cost-effectiveness analysis are needed. Even if the data to support the use of guidelines and pathways are robust, those who develop and implement them need to anticipate and understand barriers to physician adherence.

Anti-Bacterial Agents↗

PubMed2003

Acute pyelonephritis in US hospitals in 1997: hospitalization and in-hospital mortality.

PURPOSE: To describe the 1997 incidence of hospitalization for acute pyelonephritis in the US and the risk factors for in-hospital mortality associated with acute pyelonephritis. METHODS: Cases were defined as those with ICD9-CM codes corresponding to acute pyelonephritis in the 1997 Health Care Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS). Frequencies and calculations were weighted to produce either national or state estimates. Hospitalization rates were calculated using 1997 US Census Bureau population projections for the denominator. RESULTS: Females were almost five times as likely as males to be hospitalized for acute pyelonephritis (11.7/10,000 vs. 2.4/10,000), but males had higher mortality rates (16.5/1000 vs. 7.3/1000); 30% greater after adjustment. Hospitalization and in-hospital mortality rates increased with age, but not with diabetes. Mortality rates increased with number of procedures, diagnoses and having a major diagnostic category other than disorders of the kidney and urinary tract. Persons living in zip codes with lower median incomes were also at higher risk of mortality. There was little variation in mortality by hospital size, ownership, location or teaching status. CONCLUSION: In hospital mortality for pyelonephritis was associated with patient rather than hospital characteristics suggesting uniform application of standard care across hospitals and populations.

Acute Disease↗

PubMed2002

Prevalence and predictors of trimethoprim-sulfamethoxazole resistance among uropathogenic Escherichia coli isolates in Michigan.

Resistance among uropathogenic Escherichia coli to trimethoprim-sulfamethoxazole (TMP-SMX) has increased. Risk factors for resistance and the impact on clinical failure have been poorly described. We performed a retrospective cohort study of women with acute uncomplicated cystitis seen at a university health center and at primary care clinics in southeastern Michigan from 1992 to 1999. The prevalence of TMP-SMX resistance increased from 8.1% to 15.8% (P=.01). Women who had taken TMP-SMX recently were >16 times as likely as women who had not taken antibiotics recently to be infected with an isolate resistant to this agent; those who had taken any other antibiotic were more than twice as likely to be infected with a resistant isolate. Women infected with a TMP-SMX-resistant isolate who were treated with TMP-SMX were >17 times as likely to have treatment failure. Recent antibiotic use is a risk factor for infection with a TMP-SMX-resistant isolate; patients who are infected with a TMP-SMX-resistant isolate and who are treated with this agent are at a higher risk for clinical failure.

Adolescent↗

PubMed2002

Infective endocarditis in the injection drug user.

Although infective endocarditis is certainly not the most common infection seen in injecting drug users, it is the infection that clinicians most commonly think of when they consider infectious complications of injected drug use. The microbiology of infective endocarditis in injection drug users has remained relatively stable over the last several decades. Tricuspid valve endocarditis has been associated most frequently with injection drug use, but recent reports have suggested that involvement of left-sided valves is seen more often now than in the past. The use of transesophageal echocardiography has greatly advanced the ability to diagnose infective endocarditis and the cardiac complications of valvular infection.

Adult↗